- Elevance Health (Boston, MA)
- ** Claims Auditor I, II and Senior** **Location...interprets Medical Policy and Clinical Guidelines. + ** Claims Auditor Senior** - all the above, plus ... an accommodation is granted as required by law._ The ** Claims Auditor I** is responsible for pre...various aspects of the claim including eligibility, pre-authorization, and medical necessity. + Contacts others to obtain any necessary… more
- Humana (Boston, MA)
- …of our caring community and help us put health first** The Medical Coding Auditor reviews medical claims submitted against medical records provided, ... direction and receives guidance where needed. Follows established guidelines/procedures. The Medical Coding Auditor confirms correct CPT coding assignments.… more
- Commonwealth Care Alliance (Boston, MA)
- …Summary:** Working under the direction of the Sr. Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will ... (CPC) + Certified Inpatient Coder (CIC) + Certified Professional Medical Auditor (CPMA) **Desired Education (nice to...Medicare and Medicaid + 7+ years progressive experience in medical claims adjudication, clinical coding reviews for… more
- Humana (Boston, MA)
- …Bachelor's degree - Accounting, Finance, Business, Auditing, Actuarial + Certified Internal Auditor , CPA or CPC strongly preferred + Risk Adjustment knowledge + ... + Auditing experience + Familiarity with CMS Reimbursement models and claims /encounter submission processes + Data analysis and dashboarding experience + People… more