- Point32Health (Canton, MA)
- …general direction of the Member Appeals and Grievance Supervisor the Member Appeals and Grievance Analyst is responsible per State and Federal regulations ... the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works… more
- Commonwealth Care Alliance (Boston, MA)
- …to the Director, Claims Operations and Quality Assurance, the Claims Sr. Analyst plays a critical role in ensuring accurate, compliant, and timely reimbursements ... issues - including underpayments, overpayments, and disputes. The Claims Sr. Analyst serves as a subject matter expert on Medicaid (MassHealth), Medicare,… more
- CVS Health (Boston, MA)
- …with heart, each and every day. **Position Summary** The Dispute Repricing Analyst will be responsible for the accurate analysis and resolution of provider ... of claim related participation and pricing issues. + Reading and interpreting appeals , standard reference materials, etc. **Required Qualifications** + 2+ years of… more
- Intermountain Health (Boston, MA)
- …the patient's account within Intermountain's policies and procedures. Revenue Integrity Analyst II 1.Analyze data, develop reports, review trends, and recommend ... updates to charging/coding/NCCI regulations and/or errors, and regarding audits and appeals , to facilitate corrective action planning for improved processes. 7.… more
- Evolent (Boston, MA)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** ** Analyst , Client Analytics** Integrate and analyze claims and enrollment data from multiple ... Evolent's clinical services (ie, specialty care, utilization management, care management, appeals & grievances) + Using analytical tools to integrate various data… more
- Intermountain Health (Boston, MA)
- …reports and surveys, reviews audit adjustments and settlements, and files appeals and exception requests to appropriately maximize reimbursement. Interacts with ... Medicare Administrative Contractor, State Medicaid, and hospital personnel as needed. + Acts as a mentor. As assigned, coordinates training, direction and review of those working with reimbursement functions. + Manages scope and completion of work, meeting… more