- Elevance Health (Woburn, MA)
- **DRG CODING AUDITOR ** **_Virtual_** **_: _** _ _ __ _This role enables associates to work virtually full-time, with the exception of required in-person training ... recover, eliminate and prevent unnecessary medical-expense spending. The **DRG CODING AUDITOR ** is responsible for auditing inpatient medical records and generating… more
- Humana (Boston, MA)
- …our caring community and help us put health first** The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct ... established guidelines/procedures. **Where you come in** The Medical Coding Auditor confirms correct CPT coding assignments. Analyzes, enters, and manipulates… more
- Highmark Health (Boston, MA)
- …as needed. Attends meetings and interacts with management to resolve issues and provide advice on new programs. Provides guidance to system entities in response to ... and disease processes as it relates to the DRG/APC and other clinical data quality management factors. With technical direction and assistance from management,… more
- Baystate Health (Springfield, MA)
- …the work is administrative. **Job Responsibilities:** **1)** Performs detailed reviews of clinical documentation for provider services using MDAudit based on ... determined intervals per provider . Validates appropriate billing and documentation that complies with...applicable use of all carrier guidelines and review of clinical documentation. **5)** Receives and screens incoming correspondence, reports,… more
- Humana (Boston, MA)
- …us put health first** The Senior Inpatient Medical Coding Professional extracts clinical information from a variety of medical records and assigns appropriate ... be provided a bi-weekly payment for their internet expense. * Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet… more
- Boston University (Boston, MA)
- …BU Medical Campus. As a function of the QA role, this individual will provide assistance to clinical researchers regarding regulatory aspects to the conduct of ... auditor is needed. + Experience with conduct of clinical research either with pharmaceutical/device clinical trials...a function of the QA role, this individual will provide assistance to clinical researchers regarding regulatory… more
- Baystate Health (Springfield, MA)
- …health Baystate Health, western Massachusetts' only academic center and tertiary care provider has a long and proud tradition of continuous learning and improvement. ... also as a business partner to the department and clinical staff. Orients patients and families to the unit,...C Word, OA Gold, SMS, CIS, Premise, BMD, PCM Auditor , People Soft and Staples, and Kronos access if… more
- Baystate Health (Springfield, MA)
- …more! Baystate Health, western Massachusetts' only academic center and tertiary care provider has a long and proud tradition of continuous learning and improvement. ... also as a business partner to the department and clinical staff. Orients patients and families to the unit,...C Word, OA Gold, SMS, CIS, Premise, BMD, PCM Auditor , People Soft and Staples and Kronos access if… more
- Sanofi Group (Framingham, MA)
- …possible. Ready to get started? **Main Responsibilities:** + Acts as a lead auditor or co- auditor , in accordance with Sanofi processes. + Facilitates ... on pharma/biotech. + At least five years relevant experience as Quality Auditor . + Direct experience preparing for and supporting Regulatory Inspections from… more
- Commonwealth Care Alliance (Boston, MA)
- …on edits implemented. + Utilize data to examine large claims data sets to provide analysis and reports on existing provider billing patterns as compared to ... Analyst will be responsible for developing prospective claims auditing and clinical coding and reimbursement edits and necessary coding configuration requirements… more
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