- Oracle (Boston, MA)
- …this exciting arena. We are looking for a Senior Claims Denial Prevention and Appeals Specialist for providing clinical inputs to engineering for developing ... the Claim Denial Prevention and Appeals features of Oracle Health Clinical AI Agent (CAA). This role leverages expert clinical judgment and regulatory… more
- 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
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …integral part of the Credentialing & Peer Review (CPR) Team, the Peer Review Specialist works closely with CPR's Director and Clinical Lead, Operations Lead, ... healthcare? Bring your true colors to blue. The Role:The Peer Review Specialist is responsible for monitoring the quality of the credentialed practitioner/… more
- 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
- Commonwealth Care Alliance (Boston, MA)
- …provider community. In this highly visible field position, the provider relations specialist acts as the primary liaison between CCA and its providers including ... policies related to: Claims and service recovery; Program benefits; Clinical initiatives; Referral and authorization; Regulatory compliance; Billing and payments;… more