• Clinical Appeals Specialist

    Dana-Farber Cancer Institute (Brookline, MA)
    Under the general supervision of the Director of Patient Financial Services, the Clinical Appeals Specialist performs advanced level work related to ... conducting a comprehensive review of relevant clinical documentation. The Clinical Appeals Specialist will write compelling arguments based on … more
    Dana-Farber Cancer Institute (09/05/25)
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  • Appeals and Grievance Specialist

    Commonwealth Care Alliance (Boston, MA)
    011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and Grievances ... well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is responsible… more
    Commonwealth Care Alliance (08/20/25)
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  • Quality & Patient Safety Specialist…

    Beth Israel Lahey Health (Cambridge, MA)
    …skills to prepare various reports to state and federal regulators, insurance appeals , internal correspondence, and clinical summaries for medical peer review. ... & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported quality...knowledge of disease and nursing processes to write effective appeals and clinical abstracts, identifies quality of… more
    Beth Israel Lahey Health (08/08/25)
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  • Drug Authorization Specialist

    Dana-Farber Cancer Institute (Brookline, MA)
    The Drug Authorization Specialist , with direct supervision of the Prior Authorization Supervisor, is responsible for managing all work related to drug authorizations ... to all aspects of drug prior authorization work. The Drug Authorization Specialist creates accurate, thorough, and concise prior authorization requests to all payers… more
    Dana-Farber Cancer Institute (08/20/25)
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  • Coding Audit Training Specialist

    Intermountain Health (Boston, MA)
    …provides advanced training to hospital coding staff, compliance, CDI, physicians, and clinical staff. This Coordinator serves as a subject matter expert for all ... of hospital coding. The coordinator works with providers and clinical staff to make critical coding decisions based on...compliance and the CDI team. + Audits and creates appeals for all payer and regulatory denials and downgrades… more
    Intermountain Health (08/27/25)
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  • Field Medical Director, Interventional Cardiology…

    Evolent (Boston, MA)
    …guidance and expertise to ensure the application of best practices. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations ... Are you ready to make a meaningful impact on patient care in a non- clinical setting? Join our Utilization Management team as a Field Medical Director, Cardiovascular… more
    Evolent (07/30/25)
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