- 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 ... ensure that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role...Management + Collaborate system and data configuration into CES ( Claims Editing System) with BPaaS vendor and… more
- Humana (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. ... this role, you will conduct quality reviews of coding processes within the Claims Cost Management organization, including offshore and vendor partners, with a focus… more
- Cognizant (Boston, MA)
- …. Implement code editing in the Facets environments. . Test inpatient claims with the Optum grouper to ensure accuracy and compliance. . Analyze Explanation of ... a thorough understanding of standard claim payment rules for Commercial, Medicare , Medicaid , and ACA Qualified Health Plans lines of business. . Configure… more