- 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
- 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
- Baystate Health (Springfield, MA)
- …Regulatory Knowledge: A solid understanding of healthcare regulations, compliance, and reimbursement methodologies, such as Medicare , Medicaid , and ... by defining the financial impact for payment structures and reimbursement methodologies during the negotiation process will be a...and regulatory rules 2) Will be responsible for hospital Medicare and Medicaid cost report filings, audits,… more
- Humana (Boston, MA)
- …it takes to Succeed** + Bachelor's Degree + Minimum of 3 yrs health insurance claims or Medicare experience + Minimum 3 years of experience with Fraud, Waste, ... 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 (Boston, MA)
- …is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement , handle provider disputes in a result-oriented ... efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large.… more
- Cardinal Health (Boston, MA)
- …preferred + Understanding of managed care contracts and fee schedules, including Medicare and Medicaid preferred + Experience with computerized billing software ... requirements and accounts assigned + Works closely with insurance carriers for reimbursement requirements to ensure payment + Reviews outstanding AR accounts and… 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)
- …preferred. + Strong understanding of medical billing practices, payer guidelines, and reimbursement methodologies (commercial, Medicare , Medicaid ). + Proven ... team to ensure timely and accurate resolution of outstanding insurance claims . This role leads strategy development, performance monitoring, and process improvement… 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
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