- Commonwealth Care Alliance (Boston, MA)
- …provider community. In this highly visible field position, the provider relations specialist acts as the primary liaison between CCA and its providers including ... policies related to: Claims and service recovery; Program benefits; Clinical initiatives; Referral and authorization; Regulatory compliance; Billing and payments;… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …RI, CT) Under the general supervision of the Director of Patient Financial Services, the Clinical Appeals Specialist performs advanced level work related to ... conducting a comprehensive review of relevant clinical documentation. The Clinical Appeals Specialist will write compelling arguments based on … more
- Dana-Farber Cancer Institute (Brookline, MA)
- …dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and serve ... plans. Reporting to the Prior Authorization Supervisor , the Clinical Authorization Specialist is responsible for managing...+ Root causes claim denials, reprocesses, and submits claim appeals . + Creates drug cost estimates for both on-label… more
- Beth Israel Lahey Health (Cambridge, MA)
- …skills to prepare various reports to state and federal regulators, insurance appeals , internal correspondence, and clinical summaries for medical peer review. ... & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported quality...knowledge of disease and nursing processes to write effective appeals and clinical abstracts, identifies quality of… more
- Evolent (Boston, MA)
- …guidance and expertise to ensure the application of best practices. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations ... Are you ready to make a meaningful impact on patient care in a non- clinical setting? Join our Utilization Management team as a Field Medical Director, Cardiovascular… more
- Tufts Medicine (Melrose, MA)
- …of upcoming prescription refills and informs them of prior authorizations or appeals process. 7. Refers patients' concerns requiring clinical interpretation to ... or a role that focuses on support of daily business activities (eg, technical, clinical , non- clinical ) operating in a "hands on" environment. The majority of… more
