- Commonwealth Care Alliance (Boston, MA)
- …clinical, operations, pharmacy, dental, reporting, and member services. + Supports the Senior Appeals & Grievance Coordinator and A/G Coordinator in day-to-day ... 011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and Grievances… more
- CVS Health (Boston, MA)
- …**Additional Responsibilities:** Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. - Applies medical ... written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals . - Ensures all compliance requirements are satisfied and all… more
- Tufts Medicine (Boston, MA)
- …a variety of areas including employee discipline/corrective action and employee appeals and the grievance process. 2. Develops and modifies Employee Relations ... development. 9. Collaborates with colleagues to plan and organize employee recognition events. 10. Maintains collaborative, team relationships with peers and… more
- CenterWell (Boston, MA)
- …caring community and help us put health first** The **Denials Management Specialist ** is responsible to respond to, monitor and analyze all governmental requests, ... and monitoring all payer requests for additional documentation (ADR), appeals and denials. Works with branch staff to gather...Paid time off, holidays, and jury duty pay + Recognition pay + 401(k) retirement savings plan with employer… more
- Commonwealth Care Alliance (Boston, MA)
- …Reporting to the Director, Claims Operations and Quality Assurance, the Claims Sr . Analyst plays a critical role in ensuring accurate, compliant, and timely ... reimbursement issues - including underpayments, overpayments, and disputes. The Claims Sr . Analyst serves as a subject matter expert on Medicaid (MassHealth),… more
- Commonwealth Care Alliance (Boston, MA)
- …Director, Claims Operations & Quality Assurance, the Regulatory Compliance & Audits Sr . Specialist II is responsible for ensuring CCA's operational compliance ... * Translate regulatory updates into operational actions, collaborating with Claims, Appeals , UM, and Provider Services. * Conduct internal audits and retrospective… more
- Evolent (Boston, MA)
- …Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your expertise in interventional cardiology to help ensure the ... of best practices. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations (peer to peer phone calls) with requesting physicians… more