- Commonwealth Care Alliance (Boston, MA)
- …under the direction of the Sr. Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will be responsible ... Degree **Required Experience (must have):** + 7+ years of Healthcare experience, specific to Medicare and Medicaid + 7+...Medicare and Medicaid + 7+ years progressive experience in medical claims adjudication, clinical coding … more
- Highmark Health (Boston, MA)
- …for education/training of facility healthcare professionals in use of coding guidelines and practices, proper documentation techniques, medical terminology ... **GENERAL OVERVIEW:** Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data… more
- Humana (Boston, MA)
- **Become a part of our caring community and help us put health first** The Medical Coding Coordinator 3 extracts clinical information from a variety of ... medical codes (eg, ICD-10-CM, CPT) to patient records. The Medical Coding Coordinator 3 performs advanced administrative/operational/customer support duties… more
- Sedgwick (Boston, MA)
- …Medical Malpractice (Professional Liability) To analyze complex or technically difficult healthcare / medical malpractice liability claims ; to provide ... relationships. + Ensures claim files are properly documented and claims coding is correct. + Refers cases...+ Extensive knowledge and comprehension of insurance coverage + Claims expertise in medical malpractice, errors and… more
- State of Massachusetts (Quincy, MA)
- …The Medical Coder will we responsible for providing clinical coding expertise, assuring that the ICD-10 CM/PCS (10thedition of International Classification of ... Diseases Clinical Modification/Procedure Coding System) code set, and other coding ...and Reporting. * Resolve errors associated with billing and claims processing; identify and report error patterns; and design… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …colors to blue. The RoleThe Appeals Nurse Reviewer is responsible for reviewing provider claims appeals, validating coding and medical necessity of the ... provider claim appeals for medical necessity, appropriate coding , and pricing of claims for payment....we will remain relentless in our pursuit to transform healthcare for ALL. As an employer, we are committed… more
- Humana (Boston, MA)
- …+ BS in healthcare or business-related field + Knowledge of internal Medical Coverage Policies and Claims Payment Policies + Metavance and CAS ... What it takes to Succeed** + 2 years of coding certification or equivalent (Industry-recognized coding certification...from PHIA, AAPC and/or AHIMA) + Extensive knowledge of medical claims processing and familiarity with reimbursement… more
- Brown University (Providence, RI)
- …to learn about the United States Health Care System, including standard healthcare coding systems such as International Classification of Diseases versions ... data. + Some experience analyzing and managing large complex data sets, specifically healthcare claims or electronic health record datasets. + Some prior… more
- Humana (Boston, MA)
- …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... of situations or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement… more
- Humana (Boston, MA)
- …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background,...but may not be limited to, an overview of coding practices and clinical documentation, grievance and appeals processes… more
- CVS Health (Boston, MA)
- …regulations. Stay informed about changes in the industry practices related to healthcare coding . Provide training opportunities for staff to maintain their ... healthcare fraud detection, investigation, or auditing In-depth knowledge of healthcare systems, claims processing, and regulatory requirements related to … more
- Sanofi Group (Boston, MA)
- … coding , contracting, financial assistance offerings, patient support, access, medical policy and other business-related issues Neurology. In addition, they will ... patient pull though efforts. We are an innovative global healthcare company, committed to transforming the lives of people...it relates to buy & bill processes, billing and coding education, claims and adjudication by site… more
- Highmark Health (Boston, MA)
- …through analytics and reporting solutions aligned to the Quadruple Aim of Healthcare : lower per capita health care costs, improved outcomes from and quality ... identified opportunities. This position will necessitate clinical informatics and medical knowledge. **ESSENTIAL RESPONSIBILITIES** + Leads the design, development,… more
- Harvard University (Cambridge, MA)
- …variable naming protocols of projects involving electronic health records, administrative claims , and other complex databases + Create and maintain databases using ... to submit work samples (sample code) and/or complete a coding assessment. PLEASE NOTE: The finalist will be required...are primary care givers. + Health and Welfare: Comprehensive medical , dental, and vision benefits, disability and life insurance… more