- Commonwealth Care Alliance (Boston, MA)
- …Mentoring subject matter expert of the team + Managed Care experience (preferably Medicare / Medicaid ) + Experience in health plan provider relations + Experience ... + **Operational Excellence:** + Collaborate with cross-functional teams (eg, Claims , Credentialing, Clinical Care Management, Member Services, Provider Services,… more
- 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
- Danaher Corporation (Boston, MA)
- …and reimbursement landscape. + Communicate regional and local coverage and reimbursement issues for Medicare , Medicaid and Commercial payers through ... and reimbursement . + Support customers with approved resources for denied claims , payer coverage expansion and inadequate reimbursement . + Respond to and… more
- Cardinal Health (Boston, MA)
- …done. **The Accounts Receivable Specialist II is responsible for processing insurance claims and billing. They will work within the scope of responsibilities as ... and support from AR & Billing leadership teams.** **_Responsibilities_** + Processes claims : investigates insurance claims ; and properly resolves by follow-up &… more
- Humana (Boston, MA)
- …**Preferred Qualifications** + 1+ years of claims experience + 1+ years of Medicare and/or Medicaid experience + MHK knowledge + CRM knowledge + CAS ... efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large.… 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
- Beth Israel Lahey Health (Burlington, MA)
- …Knowledge & Abilities:** Comprehensive understanding and knowledge of the Center for Medicare and Medicaid Services (CMS) coding, billing and compliance ... estimates, collections for self-pay services, account initiation and coordination, claims submission, fee schedule maintenance, denials and customer service for… 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
- Humana (Boston, MA)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... Provider Contracting Professional 2 communicates contract terms, payment structures, and reimbursement rates to our Specialty providers within the Florida region.… 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
- Cardinal Health (Boston, MA)
- …organizational skills. + Understanding of managed care contracts and fee schedules, including Medicare and Medicaid . **_What is expected of you and others at ... submission for all centers. + Work closely with insurance carriers for reimbursement requirements to ensure payment. + Understand electronic claim interchange and… more
