- Highmark Health (Boston, MA)
- …system entities in response to external coding audits conducted by the Medicare Administrative Contractor, the RAC, MIC, ZPIC, etc. Determine appeal action, prepare ... Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Professional Medical Auditor (CPMA) + 5 years with hospital or physician coding and/or… more
- Datavant (Boston, MA)
- …educational and life experiences to realize our bold vision for healthcare. As an Auditor , HCC Risk Adjustment Coder, you will review medical records to identify and ... + Proficient in ICD-10 coding. + Experienced in HCC coding across Medicare , commercial, and Medicaid sectors. + In-depth knowledge of medical terminology,… more
- Humana (Boston, MA)
- …experience in revenue cycle management (related to billing, coding, collections for Medicare and Medicaid claims) + Experience with Auditing and monitoring of ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Fallon Health (Worcester, MA)
- …to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)- ... in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn. **Brief summary of purpose:** Under the general supervision of the Manager of Configuration Audit and Directories, staff will perform an audit sampling of provider… more
- Baystate Health (Springfield, MA)
- …documentation for professional billing to ensure it meets the AMA and CMS ( Medicare ) guidelines for the services billed, reviewing and validating billed charges and ... performing benchmark reporting to determine outliers. Completes a variety of analyses and reports and maintains various department databases. The incumbent routinely interacts with employees at all levels. The incumbent has an understanding of compliance audit… more
- Commonwealth Care Alliance (Boston, MA)
- …This role will ensure that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role will also be responsible for ... as necessary on all new and revised coding logic, related Medicare /Medicaid policies for review/approval through the Payment Integrity governance process.… more
- Beth Israel Lahey Health (Charlestown, MA)
- …deep knowledge of both government and commercial payment systems; and, (4) Provide Medicare , Medicaid, and payment system expertise in support of BILH provider and ... VP and AVP, the Director will develop long- and short- term Medicare , Medicaid, and other government reimbursement revenue strategies, oversee preparation and… more
- Elevance Health (Hingham, MA)
- …member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services ... programs. The **Audit and Reimbursement II** will support our Medicare Administrative Contract (MAC) with the federal government (The...on cost report audits, may serve as an in-charge auditor on less complex audits Dependent upon experience, may… more
- Baystate Health (Springfield, MA)
- …applications in daily work: C Word, OA Gold, SMS, CIS, Premise, BMD, PCM Auditor , People Soft and Staples and Kronos access if applicable. **3)** Unit specific ... to transfer and discharge. Explains and obtains signatures for Medicare forms. Organizes chart for Medical Records, faxes or...record on unit. When appropriate, enter data into PCM auditor at specified times. Replenish and restock unit audit… more
- Baystate Health (Springfield, MA)
- …in daily work: C Word, OA Gold, SMS, CIS, Premise, BMD, PCM Auditor , People Soft and Staples, and Kronos access if applicable. **3)** Unit-specific projects: ... to transfer and discharge. Explains and obtains signatures for Medicare forms. Organizes charts for Medical Records, and faxes...the unit. When appropriate, enter data into the PCM auditor at specified times. Replenish and restock unit audit… more