• Medicare/Medicaid Claims Reimbursement Specialist

    Commonwealth Care Alliance (Boston, MA)
    …to the Director, Claims Operations and Quality Assurance, the Claims Sr. Analyst plays a critical role in ensuring accurate, compliant, and timely reimbursements ... issues - including underpayments, overpayments, and disputes. The Claims Sr. Analyst serves as a subject matter expert on Medicaid (MassHealth), Medicare,… more
    Commonwealth Care Alliance (05/31/25)
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  • Medicare/Medicaid Claims Editing Specialist

    Commonwealth Care Alliance (Boston, MA)
    …TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will be responsible for developing prospective claims auditing and clinical ... coding and reimbursement edits and necessary coding configuration requirements for Optum CES and Zelis edits. This...Integrity, Payment Integrity, and Analytics + 5+ years of Facets Claims Processing System **Required Knowledge, Skills & Abilities… more
    Commonwealth Care Alliance (05/28/25)
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