• Commonwealth Care Alliance (Boston, MA)
    …initiatives to achieve high performance on CCA's Population Health goals; including Medicare Star measures, Medicaid - Medicare Plan withhold measures, quality ... CAHPS, HOS) and value-based contract performance metrics + Experience with Medicare Advantage, Medicaid ; and dually eligible populations **Desired Experience**… more
    DirectEmployers Association (10/29/25)
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  • Commonwealth Care Alliance (Boston, MA)
    …Required Knowledge, Skills & Abilities (must have): - Strong understanding of claims processing, reimbursement methodologies, and payment policies, with the ... their impact on provider operations and satisfaction. - Strong understanding of Medicare and Medicaid health plan operations, including regulatory and compliance… more
    DirectEmployers Association (10/18/25)
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  • Commonwealth Care Alliance (Boston, MA)
    …experience + Experience in health plan provider relations. **Experience (Desired)** + Medicare / Medicaid experience preferred. + Experience with CPT coding and ... with key providers; orient providers on CCA's policies related to: Claims and service recovery; Program benefits; Clinical initiatives; Referral and authorization;… more
    DirectEmployers Association (10/18/25)
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  • Commonwealth Care Alliance (Boston, MA)
    …Mentoring subject matter expert of the team + Managed Care experience (preferably Medicare / Medicaid ) + Experience in health plan provider relations + Experience ... + **Operational Excellence:** + Collaborate with cross-functional teams (eg, Claims , Credentialing, Clinical Care Management, Member Services, Provider Services,… more
    DirectEmployers Association (10/17/25)
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  • Medicare / Medicaid Claims…

    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 (08/31/25)
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  • Medicaid Provider Hospital…

    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 Developing… more
    Humana (11/17/25)
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  • Sr. Medicare (PPS) Provider Hospital…

    Humana (Boston, MA)
    …Senior Business Intelligence Engineer will develop and maintain expertise in complex Medicare reimbursement methodologies. This role is within the Integrated ... on Pricer edit resolution + Provide consultation to internal business partners on Medicare reimbursement /editing logic and Humana system logic **Use your skills… more
    Humana (10/18/25)
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  • ACA/ Medicare Risk Adjustment Analyst Sr.

    Baylor Scott & White Health (Boston, MA)
    …paced environment independently and with cross functional groups.Knowledge of ACA, Medicare , Medicaid , MCO, TPA business requirements preferred.Experience with ... and outbound encounter process. + Monitors and oversees the end-to-end claims encounter management workflow. + Identifies and interprets encounter data, submission… more
    Baylor Scott & White Health (10/03/25)
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  • Senior Field Reimbursement Manager - North…

    Danaher Corporation (Boston, MA)
    …and reimbursement landscape. + Communicate regional and local coverage and reimbursement issues for Medicare , Medicaid and Commercial payers through ... and reimbursement . + Support customers with approved resources for denied claims , payer coverage expansion and inadequate reimbursement . + Respond to and… more
    Danaher Corporation (10/15/25)
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  • Sr. Provider Reimbursement Professional…

    Humana (Boston, MA)
    …certification from the AAPC and/or AHIMA) + Extensive knowledge of medical claims processing and familiarity with reimbursement methodologies, ICD, CPT, and ... efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large.… more
    Humana (11/21/25)
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