- 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 Developing… more
- 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
- 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
- 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
- WellSense (MA)
- …according to pre-set site visit servicing standards** + **Acts as liaison for all reimbursement , credentialing, claims , EDI web site procedures and issues of key ... transportation** **Competencies, Skills, and Attributes:** + **Knowledge or familiarity with Medicaid and Medicare required** + **Understanding of the local… more
- 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
- 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
- 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
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