- Humana (Boston, MA)
- …is a full-time, remote/work-from-home position. **Description** The Inpatient Medical Coding Auditor extracts clinical information from medical records and ... Quality Team is looking is an experienced and well-grounded medical coding auditor to quality review the inpatient hospital claims for proper reimbursement, handle… more
- Fallon Health (Worcester, MA)
- …the nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, ... health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid, and PACE (Program… more
- Elevance Health (Woburn, MA)
- **DRG CODING AUDITOR ** **Location** : _This position will work virtually._ _Alternate locations may be considered._ The **DRG CODING AUDITOR ** is responsible for ... for all lines of business, and its clients. Also responsible for performing clinical reviews of medical records and other documentation to evaluate issues of coding… 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)
- …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
- 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
- Brockton Hospital (Brockton, MA)
- Signature Healthcare is Southeastern Massachusetts' premier local provider of quality, personalized medical services. We are comprised of the award-winning ... government program requirements. Clearly communicate such requirements to management, clinical and operations staff. Conducts and coordinates compliance investigations… more
- Cardinal Health (Boston, MA)
- …a global manufacturer and distributor of medical and laboratory products, and a provider of performance and data solutions for health care facilities. We are a ... crucial link between the clinical and operational sides of care, working with more...+ Experience in analyzing data and creating reports/dashboards/views to provide visibility into risk and control landscape. + An… more
- State of Massachusetts (Everett, MA)
- …comprehensive, and accurate. 2. Establish and maintain effective supervision structures. Provide timely supervision and direct support to PRS Supervisors, including ... other team staff. Develops and maintains a cohesive staff unit, to provide an opportunity for staff, supervisors, and/or administrators to share information,… more