- Humana (Boston, MA)
- …us put health first** CenterWell Senior Primary Care (PCO) is a growing provider organization that currently operates about 340+ senior focused primary care centers ... business partners to uphold ethical standards and mitigate risks. The Senior Clinical Compliance Professional will support the Director of Compliance, by ensuring… more
- Elevance Health (Woburn, MA)
- **DRG Coding Auditor Principal** _Virtual: This role enables associates to work virtually full-time, providing maximum flexibility and autonomy. This approach ... and skill development. Alternate locations may be considered._ The DRG Coding Auditor Principal is responsible for auditing inpatient medical records on claims paid… 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
- Cognizant (Boston, MA)
- We strive to provide flexibility wherever possible. Based on this role's business requirements, this is a remote position open to qualified applicants in the United ... and compliance with regulatory and organizational standards. - **Enhance Clinical Documentation Quality** . Collaborate with physicians through a structured… 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
- 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
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