- 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
- 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
- Cognizant (Boston, MA)
- …GED *Proven experience working in healthcare revenue cycle with specializing in hospital claims . *Expertise in Medicare , Medicaid , Managed Care, and ... you will perform advanced level work related to resolution of hospital claims . You will be responsible for resolving aged hospital accounts receivables, identifying… 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
- 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
- Prime Therapeutics (Boston, MA)
- …internal stakeholders to research and resolve regulatory inquiries/complaints related to claims , contracting and pharmacy reimbursement . Works directly with ... or PBM organization, or other highly regulated industry, including experience with Medicare , Medicaid , and the Affordable Care Act (ACA) + Must be eligible to… more