• Medicare/Medicaid Claims Reimbursement Specialist

    Commonwealth Care Alliance (Boston, MA)
    …on Medicaid (MassHealth), Medicare, and commercial payment methodologies and supports audit , compliance, and provider engagement initiatives. This role also provides ... outcomes in claims systems (eg, Salesforce, Facets) in compliance with audit standards and MassHealth requirements. + Maintain awareness of MassHealth transmittals,… more
    Commonwealth Care Alliance (05/31/25)
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  • Senior Clinical Staff Educator

    Tufts Medicine (Lawrence, MA)
    …Part-Time, 24 Hour - Days (Varied Days)** **Required Education and Experience:** + RN with minimum 1-2 years home care experience. + 1-2 years' experience in ... Responsibilities:** + Assist in the assessment of staff education needs audit , results from clinical record reviews, patient satisfaction surveys, incident reports… more
    Tufts Medicine (07/29/25)
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  • Certified Professional Coder 2

    Beth Israel Lahey Health (Burlington, MA)
    …denials in Cobius Denial Software and determine appropriate resolution based on audit . 10. Works with Clinical Decision Specialists regarding MD Queries and ... CPC-H Experience: + Minimum five years of hospital inpatient coding experience and/or an RN or other healthcare clinician with at least 5 years acute care experience… more
    Beth Israel Lahey Health (07/18/25)
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  • Database Developer (Healthcare / Risk Adjustment)

    Commonwealth Care Alliance (Boston, MA)
    …systems integration and enhance the risk adjustment data ecosystem. + Support audit readiness and regulatory compliance for Medicare and Medicaid risk adjustment ... record, (if applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer.… more
    Commonwealth Care Alliance (06/25/25)
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  • Appeals and Grievance Specialist

    Commonwealth Care Alliance (Boston, MA)
    …application of the member enrollment database system to ensure successful audit preparation; supports the review data for completeness and accuracy. **Working ... record, (if applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer.… more
    Commonwealth Care Alliance (05/21/25)
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