- 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 ... ensure that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role...Management + Collaborate system and data configuration into CES ( Claims Editing System) with BPaaS vendor and… more
- Humana (Providence, RI)
- …on Pricer edit resolution + Provide consultation to internal business partners on Medicare reimbursement/ editing logic and Humana system logic **Use your skills ... closely with IT, the pricing software vendor, CIS BSS, claims operations, and other business teams involved in the...to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel,… more
- Humana (Providence, RI)
- …Disputes team reviews and educates providers when there is a dispute on adjudicated claims that contain a code editing related denial or financial recovery. The ... Demonstrate ability to problem-solve complex coding issues + Experience with Medicare and Medicaid coding guidelines + Strong data entry and attention to detail… more