- Otsuka America Pharmaceutical Inc. (Boston, MA)
- The Senior Manager , External Engagement Strategic Planning will play a critical role in shaping and executing strategic initiatives that enhance the impact of ... + Strong understanding of the US & Global healthcare landscape, including payer and policy environments + Excellent communication, leadership, and project management… more
- Brockton Hospital (Brockton, MA)
- …criteria and guidelines to conduct review of inpatient admissions. The Case Manager at Brockton Hospital serves as the primary liaison between PCP/attending ... physician, patient/family, payer based case managers, and appropriate community based providers. High school diploma or equivalent required. Bachelor's Degree… more
- Sanofi Group (Cambridge, MA)
- …related to coverage, reimbursement and patient access. Reporting directly to the General Manager , US RGA Franchise, this role will act as a thought partner and ... a team working cross-functionally to manage the performance of the payer channels, including accountability for tracking and improving targeted account performance,… more
- Beth Israel Lahey Health (Woburn, MA)
- …their homes and communities in accordance with home care regulations and payer guidelines. **More Specifically** : + Complete and document an initial assessment ... of patient and family to determine home care needs; + Initiates the plan of care and makes necessary revisions as patient status and needs change; + Administers medications and treatments as prescribed by the physician; + Instruct, supervise, and evaluate the… more
- Beth Israel Lahey Health (Woburn, MA)
- …their homes and communities in accordance with home care regulations and payer guidelines. **More Specifically** : + Coordinate care for assigned patient caseload ... including but not limited to: delegating to and supervising of PTA staff (if applicable), processing patient condition change visits, and completing OASIS time points. + Complete and document an initial assessment of patient and family to determine home care… more
- CenterWell (Boston, MA)
- …billing operations with a focus on contract interpretation, validation, and payer setup. This role works collaboratively with internal departments, professional ... additional duties as assigned to meet departmental needs. **Key Responsibilities:** + ** Payer Setup:** Create and manage payer configurations, ensuring accuracy… more
- Beth Israel Lahey Health (Beverly, MA)
- …eligibility for visit, using various online tools and by contacting the payer directly. (essential) 2. Identifies payer medical necessity determination before ... 3. Determines authorization requirement and, when necessary, obtains authorization from payer by utilizing payer specific protocols. Requests and coordinates… more
- Beth Israel Lahey Health (Charlestown, MA)
- …payment and denial data down to the line item detail, identifying payer and coding trends, risks, and opportunities, to implement operational or systematic ... party payers. Research, develop and maintain a solid understanding of payer requirements, including filing limit, claim processing logic, coordination of benefits… more
- Beth Israel Lahey Health (Charlestown, MA)
- …making a difference in people's lives.** Under oversight of the Department Manager , the Senior Specialist Patient Financial Services - Hospital Billing will be ... various work queues to completion and communicate to the Manager within the designated time frame (essential). * Contacts...demonstrates proper handling and escalation as needed. * Handles payer 277 rejections on accounts with the highest level… more
- Beth Israel Lahey Health (Charlestown, MA)
- …will operate in a fully remote capacity** Under oversight of the Department Manager & Supervisor, the Patient Financial Services Specialist - Hospital Billing will ... **Communicates all claims/data problems that cannot be handled to the Supervisor/ Manager within one (1) day of identifying the problem.** **Identifies and… more
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