- CVS Health (Boston, MA)
- …each and every day. **Position Summary** The Quality Specialist will audit pre and post payment claims for accuracy and eligibility transactions. They ... identifying errors, necessary corrective measures, and may participate in special audit assignments. **Required Qualifications** + 1+ years of experience working in… more
- Commonwealth Care Alliance (Boston, MA)
- …will not be considered at this time._** **Position Summary:** Reporting to the Director, Claims Operations and Quality Assurance, the Claims Sr. Analyst ... Advantage programs. Under the direction of the Director of Claims Operations and Quality Assurance, this role...claims systems (eg, Salesforce, Facets) in compliance with audit standards and MassHealth requirements. + Maintain awareness of… more
- Commonwealth Care Alliance (Boston, MA)
- …Experience (must have): * 5+ years in healthcare compliance, regulatory affairs, or claims audit . * Experience working with TPA partners (eg, Cognizant) and ... not be considered at this time._** Position Summary: Reporting to the Director, Claims Operations & Quality Assurance, the Regulatory Compliance & Audits Sr.… more
- Beth Israel Lahey Health (Burlington, MA)
- …and maintains open communication with third party payor representatives in order to resolve claims issues. 4. Reviews claim forms for the accuracy of procedures, ... provider documentation in order to determine appropriate coding and initiate corrected claims and appeals. Duties include hands on coding, documentation review and… more
- Beth Israel Lahey Health (Burlington, MA)
- …taking a job, you're making a difference in people's lives.** The PFS Denial Specialist I role is vital to ensure that hospital denied accounts are thoroughly ... for any opportunity to correct, refile and or appeal claims for re-processing and reimbursement. The role also includes...with third party payor representatives in order to resolve claim issues. 5. Utilize CAC or other electronic coder… more
- Robert Half Accountemps (Nashua, NH)
- Description We are looking for a dedicated Patient Access Specialist to join our team in Nashua, New Hampshire. In this Contract-to-permanent role, you will play a ... input benefit details to facilitate billing processes and maintain a high clean claim rate. * Screen medical necessity for Medicare patients using specialized tools… more
- Elevance Health (Woburn, MA)
- …letters. + Maintains accuracy and quality standards as set by audit management for the auditing concept, valid claim identification, and documentation ... responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit of...purposes (eg, letter writing). + Identifies new claim types by identifying potential claims outside… more
- Boston Public Schools (Boston, MA)
- …school and program locations to ensure program meal accountability and operational quality at each location + Conducts an annual site operational performance and ... compliance audit of each assigned school kitchen or program location...are accurate and complete for timely submission of monthly claims . + Monitors supply and labor costs by management… more