- Commonwealth Care Alliance (Boston, MA)
- … Claims Sr. Analyst serves as a subject matter expert on Medicaid (MassHealth), Medicare , and commercial payment methodologies and supports audit, compliance, ... + Certified Professional Coder (CPC) - AAPC + Certified Claims Professional (CCP) + Other AHIMA or Medicaid...to have):** + Prior experience working with MassHealth and Medicare Advantage reimbursement rules is strongly preferred.… more
- Commonwealth Care Alliance (Boston, MA)
- …and medical coding (CPT, HCPCS, Modifiers) along with the application of Medicare /Massachusetts Medicaid claims ' processing policies, coding principals and ... Coding Sr. Analyst will be responsible for developing prospective claims auditing and clinical coding and reimbursement ...new CPT and HCPCS codes for coding logic, related Medicare / Medicaid policies to make recommend reimbursement… more
- Humana (Boston, MA)
- …The Senior Business Intelligence Engineer will develop and maintain expertise in Medicaid reimbursement methodologies rooted in complex grouping concepts (EAPG, ... Business Intelligence Engineer will be responsible for: + Researching state-specific Medicaid reimbursement methodologies for hospitals and facilities +… more
- Humana (Boston, MA)
- …days/week. **Required Qualifications** + Bachelor's Degree + Minimum of 3 yrs health insurance claims or Medicare experience + Minimum 3 years of experience with ... continuously improving consumer experiences **Preferred Qualifications** + Proven knowledge in Medicare and Medicaid regulations + Certifications (BA, MBA, JD,… more
- CenterWell (Boston, MA)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... caring community and help us put health first** The Claims Processing Representative 2 adjudicates pharmacy claims ...The Claims Processing Representative 2 adjudicates pharmacy claims and processes pharmacy claims for payment… more
- Cardinal Health (Boston, MA)
- …a lot of different hats, without getting overwhelmed), required * Clear knowledge of Medicare (A, B, C, D), Medicaid & Commercial payers' policies and guidelines ... a background in healthcare (such as medical assistant, working in medical claims /billing, pharmacy technician, clinician in a doctor's office, etc) or with insurance… more
- Tufts Medicine (Boston, MA)
- …Facilitates the reimbursement for clinical services provided to patients. Submits claims to health insurers, follows up with health insurers about submitted ... claims , and performs appeals for non-clinical denials, etc. An...can access the care they need and to ensure reimbursement to Tufts Medicine for the services provided. **Job… more
- Cardinal Health (Boston, MA)
- …done. **The Accounts Receivable Specialist II is responsible for processing insurance claims and billing. They will work within the scope of responsibilities as ... and support from AR & Billing leadership teams.** **_Responsibilities_** + Processes claims : investigates insurance claims ; and properly resolves by follow-up &… more
- Beth Israel Lahey Health (Burlington, MA)
- …Knowledge & Abilities:** Comprehensive understanding and knowledge of the Center for Medicare and Medicaid Services (CMS) coding, billing and compliance ... estimates, collections for self-pay services, account initiation and coordination, claims submission, fee schedule maintenance, denials and customer service for… more
- Cardinal Health (Boston, MA)
- …and/or hospital facility fee coding and auditing. + Expert-level knowledge of Medicare and Medicaid documentation and coding rules and guidelines; ... patient medical records. + Availability to assist with research of denied claims . + Maintains a functional knowledge of enterprise EMRs, the registration process… more