- Humana (Boston, MA)
- …a part of our caring community and help us put health first** The Compliance Nurse Auditor reviews utilization management activities and documentation to ... to prevent and detect fraud, waste, and abuse. The RN Compliance Nurse 2, Quality...past 3 years + Experience as a Utilization Management Auditor + Health Plan experience working with large carriers… more
- Brockton Hospital (Brockton, MA)
- …focus on government payers, including Medicare and Medicaid. Collaborate with SHC's Healthcare's Compliance Auditor to meet audit plan objectives. + Works with ... in the lives and health of our patients. The Assistant Director, Corporate Compliance (Assistant Director) is a member of the Compliance Department and… more
- CVS Health (Boston, MA)
- …and external partners. Ability to travel for business needs. **Preferred Qualifications:** Registered Nurse ( RN ) Previous leadership experience. AAPC Coding ... CPC's, working closely with internal and external stakeholders and ensuring compliance with regulatory requirements. The Manager develops strategies to manage… more
- Commonwealth Care Alliance (Boston, MA)
- …Program + Contribute towards the maintenance and enhancement of an effective Compliance Monitoring Program + Contribute towards the maintenance and enhancement of an ... effective Compliance Risk Assessment Program + Project manage regulator and...CAP Program. + Provide guidance and mentoring to Internal Auditor (s) in the scope of their daily responsibilities. +… more
- 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 for developing ... Coder (CPC) + Certified Inpatient Coder (CIC) + Certified Professional Medical Auditor (CPMA) **Desired Education (nice to have):** + Masters Degree **Required… more