- 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 +… more
- Humana (Boston, MA)
- …Rico. + 2 years TRICARE claims experience to include professional and institutional claims reimbursement + Strong knowledge of TRICARE policy and claims ... caring community and help us put health first** The Claims Risk Management Professional is responsible for ensuring payment...to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel,… more
- Tufts Medicine (Boston, MA)
- …Facilitates the reimbursement for clinical services provided to patients. Submits claims to health insurers, follows up with health insurers about submitted ... claims , and performs appeals for non-clinical denials, etc. An...can access the care they need and to ensure reimbursement to Tufts Medicine for the services provided. **Job… 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
- CVS Health (Boston, MA)
- …DME claims and invoices to governmental and commercial insurance companies for reimbursement for our patients' insurance claims . In this role, you will ... working with commercial insurance companies and/or governmental payers, including Medicare and Medicaid . **Preferred Qualifications** + Strong attention… more
- Humana (Boston, MA)
- …and well-grounded medical coding auditor to quality review the 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
- Tufts Medicine (Tyngsboro, MA)
- …billing edits, claim edits, payer follow-up, correspondence review, corrected claims , appeals, reimbursement verification, and remittance for assigned ... knowledge of coverage eligibility and the application of Commercial, Blue Cross, Medicare , Medicaid , Managed Care, and other third-party payor rules,… more
- Dana-Farber Cancer Institute (Brookline, MA)
- … reimbursement systems. + In-depth knowledge of healthcare regulations, including Medicare and Medicaid billing and medical record documentation requirements. ... compliance as well as revenue cycle operations. + Advanced knowledge of reimbursement systems and an understanding of basic random sampling and statistical analysis.… more
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