- Bear Mountain Health Care (MA)
- …Home Medicaid EXPERT? Bear Mountain Healthcare is currently seeking a full time Medicaid Pending Specialist to assist in the completion of Medicaid ... facilities in Massachusetts. Duties include: . Responsible for working Pending Medicaid applications and re-determinations in order to ensure financial eligibility.… more
- Commonwealth Care Alliance (Boston, MA)
- …that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role will also be responsible for timely review and ... as necessary on all new and revised coding logic, related Medicare/ Medicaid policies for review/approval through the Payment Integrity governance process.… more
- Commonwealth Care Alliance (Boston, MA)
- …The Claims Sr. Analyst serves as a subject matter expert on Medicaid (MassHealth), Medicare, and commercial payment methodologies and supports audit, compliance, and ... - AAPC + Certified Claims Professional (CCP) + Other AHIMA or Medicaid billing-related certifications **Required Experience (must have):** + 3+ years in healthcare… more
- Open Sky Community Services (Worcester, MA)
- …Open Sky's Finance team is in search of an Accounts Receivable Specialist with extensive experience in behavioral health billing and accounts receivable follow ... work under the direction of the Third-Party Billing Manager. The Accounts Receivable Specialist will be responsible for the follow-up with third party payers on… more
- Dana-Farber Cancer Institute (Boston, MA)
- …to the Director of Patient/Family Relations, the Patient / Family Relations (P/FR) Specialist serves as an integral member of the Quality and Patient Safety ... to ensure personalization and humanization of the hospital experience. The P/FR Specialist will support the Patient / Family Relations program at the Institute,… more
- Molina Healthcare (Cambridge, MA)
- **Job Description** **Job Summary** The Specialist , Member & Community Interventions implements new and existing clinical quality member intervention initiatives ... including all lines of business (Medicare, Marketplace, Medicaid ) Executes health plan's member and community quality focused...+ 1 year of experience in Medicare and in Medicaid managed care + Certified Professional in Health Quality… more
- Prime Therapeutics (Boston, MA)
- …every decision we make. **Job Posting Title** Medication Therapy Management Specialist **Job Description** The Medication Therapy Management (MTM) Service ... Specialist is responsible for receiving inbound and making outbound...targeted population; for Medicare, is Centers for Medicare & Medicaid Services (CMS) compliance compliant + Utilize Prime's MTM… more
- Fenway Health (Boston, MA)
- Behavioral Health Substance Use Disorder Specialist Boston, MA (http://maps.google.com/maps?q=1340+Boylston+St+Boston+MA+USA+02215) * Behavioral Health Job Type ... of the Manager of Integrated Behavioral Health Services, the Behavioral Health Specialist with specialty in evaluating and treating substance use disorder (SUD)… more
- Highmark Health (Boston, MA)
- …goals including but not limited to Government Markets (STARS, ACA, CHIP, Medicaid DE) and Enterprise Quality, Safety, and Values (Health Outcomes Measures). Provide ... share models and will be implemented for the Organization's Medicare Advantage, Medicaid , ACA, and commercial populations with the goal of maximizing quality while… more
- Commonwealth Care Alliance (Boston, MA)
- …Claims Operations & Quality Assurance, the Regulatory Compliance & Audits Sr. Specialist II is responsible for ensuring CCA's operational compliance with state and ... federal healthcare regulations, particularly MassHealth (Massachusetts Medicaid ) and CMS Medicare requirements. This role is housed within the Claims Operations &… more
- Cognizant (Boston, MA)
- …on the review of clinical documentation in accordance with Medicare, Medicaid , and third-party guidelines. . Effectively document and log claims/appeals information ... on relevant tracking systems . Utilize critical thinking skills to interpret guidelines of internal policies for clinical determination. . Medical Necessity Reviews can be based on InterQual, Milliman Clinical Guidelines (MCG), Medicare guidelines, and health… more
- Cardinal Health (Boston, MA)
- …center or customer service environment, preferred + Clear knowledge of Medicare, Medicaid & Commercial payer policies and guidelines for coverage, preferred + ... Knowledge of Diagnostic Medical Expense and Medicare Administrative Contractor practices, preferred + Clear understanding of Medical, Supplemental, and pharmacy insurance benefit practices, preferred + Excellent written and oral communication, mediation, and… more
- Molina Healthcare (Cambridge, MA)
- …and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research and resolution ... of the appeals from Molina members, providers and related outside agencies to ensure that internal and/or regulatory timelines are met. + Research claims appeals using support systems to determine Medicare appeal and claim outcomes. + Requests and reviews… more
- East Boston Neighborhood Health Center (MA)
- … Medicaid , or Special Needs populations. Certifications (CHW, Engagement Specialist , Medical Assistant) preferred. + Transportation: Valid Driver's license and ... diverse populations. + Assist with access to community resources, Medicaid applications, and benefits. Qualifications: + Education: Bachelor's Degree preferred… more
- Commonwealth Care Alliance (Boston, MA)
- …the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for conducting centralized clinical review and authorization creation ... * Maintain up-to-date knowledge of and compliance with CMS, NCQA and state Medicaid requirements. * Lead preparation for internal and external audits (eg CMS Program… more
- Humana (Boston, MA)
- …the team as a Senior Product Manager working anywhere in the US. As a Specialist in NBA Execution, you'll play a hands-on role in translating strategy into real-time ... are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal… more
- Hannaford (Leominster, MA)
- …support staff. * Work with the designated in-store trainer and pharmacy training specialist to ensure proper and efficient training of all pharmacy personnel. * ... integrity, professionalism, and confidentiality. Authorization to fill Medicare and Medicaid prescriptions. Physical Requirements * Accurate and efficient typing… more
- Cardinal Health (Boston, MA)
- …skills and prioritizes getting the right things done. **The Accounts Receivable Specialist is responsible for processing insurance claims and billing. They will work ... with secondary insurance company when necessary. + Bills supplemental insurances including all Medicaid states on paper and online. + Mails all paper claims. + Acts… more
- Commonwealth Care Alliance (Springfield, MA)
- …medical record strongly preferred (EPIC and eCW a plus) + Experience with Medicaid or Medicare programming and insurance products (ie ACO, MCO, PACE or SCO) ... assessment tools (eg, PHQ 2, PHQ 9) + Demonstrates understanding of Referral to Specialist . + Ability to conduct and document a Pain Assessment, Mental Health, SUD,… more
- Commonwealth Care Alliance (Springfield, MA)
- …and emergency department use + Supports patient retention and connection to Medicaid and Medicare benefits + Conducts health education on key quality measures ... have):** **Desired Licensing (nice to have):** + CHW Certification + Housing Specialist + Certified Application Counselor (CAC) + Certified Addiction Recovery Coach… more