- 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)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... caring community and help us put health first** The Claims Review Representative makes appropriate claim decision based on...match + Generous Paid Time Off accrual + Tuition Reimbursement + Parent Leave **Work at Home Requirements** +… more
- J&J Family of Companies (Manchester, NH)
- …approval processes and business acumen. . Understanding of Medicare , Medicaid , and private payer initiatives affecting reimbursement of pharmaceutical and ... . Educate HCPs on product coverage, prior authorizations and appeals, reimbursement processes, claims submissions, procedures, and coding requirements of… 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)
- …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
- 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
- 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
- Tufts Medicine (Melrose, 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