- Commonwealth Care Alliance (Boston, MA)
- …compliance requirements. + Maintain a solid understanding of Medicare and Medicaid reimbursement methodologies for assigned services. + Conduct on-going ... and health care financing required. + Solid understanding of Medicare and Medicaid reimbursement methodologies and particular expertise in Medicare and … more
- Commonwealth Care Alliance (Boston, MA)
- …teams to monitor network performance against internal and regulatory benchmarks. - Ensure provider network compliance with CMS, state Medicaid agency, and NCQA ... 011230 CA- Provider Engagement & Performance Position Summary: The Director...contracting, or population health initiatives. - Prior work with hospital systems, large medical groups, and specialty care networks.… more
- Commonwealth Care Alliance (Boston, MA)
- …and strengthening relationships with the Commonwealth Care Alliance's (CCA) diverse provider community - including physician, hospital , behavioral health, ... Mentoring subject matter expert of the team + Managed Care experience (preferably Medicare/ Medicaid ) + Experience in health plan provider relations + Experience… more
- Somatus (Nashua, NH)
- …country living with chronic kidney disease to experience more days out of the hospital and healthier at home. It takes a village of passionate and tenacious ... of 3 weeks' Vacation (PTO) + Professional Development, CEU, and Tuition Reimbursement + Curated Wellness Benefits supporting teammates physical and mental well-being… more
- Humana (Boston, MA)
- …our caring community and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business ... the Pricer Business and System Support team responsible for administering complex Medicaid provider reimbursement methodologies. The associate will support… more
- Humana (Boston, MA)
- …part of our caring community and help us put health first** The Medicare (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business ... Pricer Business and System Support team responsible for administering complex Medicare provider reimbursement methodologies. The business needs of the team… more
- Commonwealth Care Alliance (Boston, MA)
- …teams to monitor network performance against internal and regulatory benchmarks. * Ensure provider network compliance with CMS, state Medicaid agency, and NCQA ... 011230 CA- Provider Engagement & Performance Position Summary: The Director...contracting, or population health initiatives. * Prior work with hospital systems, large medical groups, and specialty care networks.… more
- Humana (Boston, MA)
- … Provider Contracting Professional 2 initiates, negotiates, and executes physician, hospital , and/or other provider contracts and agreements. The Provider ... years of experience servicing or negotiating managed care contracts with physician, hospital and/or other provider contracts + Proficiency in analyzing,… more
- Beth Israel Lahey Health (Charlestown, MA)
- …(2) Produce data and analytics that deliver actionable business insights to BILH hospital , physician, and system leaders; (3) Provide strategic solutions that ... applying a deep knowledge of both government and commercial payment systems; and, (4) Provide Medicare, Medicaid , and payment system expertise in support of BILH… more
- Cardinal Health (Boston, MA)
- …Managed Care oversees the interactions that take place between payer and provider (s) to ensure optimal reimbursement including managed care contracting, ... Functions:** + Responsible for documenting and tracking all credentialing, re-credentialing, provider enrollment, and hospital privileging activities within the… more
- Humana (Boston, MA)
- …coding auditor to review inpatient hospital claims for proper reimbursement , handle provider disputes in a result-oriented and metrics-driven environment. ... Coding Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims… more
- BrightSpring Health Services (Hudson, MA)
- Our Company Amerita Overview Amerita, Inc. is a leading provider in home Infusion therapy. We are looking for an Intake Coordinator to join our Intake team as we ... of infusible drugs coming to market, and an industry shift from hospital delivery settings to lower-cost, high-quality alternative providers such as Amerita. As… more
- Cambridge Health Alliance (Somerville, MA)
- …(ARC) or American Heart Association (AHA)BLS certification required + Experience: Hospital Care Management Experience strongly preferred. + Provider Minimum ... medical illness. Casework or therapy takes place in the hospital setting. Summary: Under the general supervision of the...and efficient patient care consistent with the Centers for Medicaid and Medicare Conditions of Participation. The RN Case… more
- Cambridge Health Alliance (Everett, MA)
- …Case Management Everett **Requisition Number:** 8001 **Location:** CHA Everett Hospital **Work Days:** 8-4:30pm including weekend rotation **Category:** Registered ... medical illness. Casework or therapy takes place in the hospital setting. Under the general supervision of the Director...and efficient patient care consistent with the Centers for Medicaid and Medicare Conditions of Participation. The RN Case… more
- Fresenius Medical Center (Saugus, MA)
- …2,600+ dialysis centers, 350+ research sites across North America + Largest provider of renal care products and services in the nation, including state-of-the-art ... renal specialty laboratories + Up to $5,200 RN tuition reimbursement per calendar year Great for Nursing Assistants ,...and dialysate flow (QD). + Evaluate intradialytic problems and provide intervention as prescribed by physician order or as… more
- Fresenius Medical Center (Roxbury, MA)
- …2,600+ dialysis centers, 350+ research sites across North America + Largest provider of renal care products and services in the nation, including state-of-the-art ... renal specialty laboratories + Up to $5,200 RN tuition reimbursement per calendar year Great for Nursing Assistants ,...and dialysate flow (QD). + Evaluate intradialytic problems and provide intervention as prescribed by physician order or as… more
- Cambridge Health Alliance (Somerville, MA)
- …(ARC) or American Heart Association (AHA)BLS certification required + Experience: Hospital Care Management Experience strongly preferred. + Provider Minimum ... of effective and efficient patient care consistent with the Centers for Medicaid and Medicare Conditions of Participation. The RN Case Manager will collaborate… more
- Atrius Health (Newton, MA)
- …along with 420 additional clinicians, work in close collaboration with hospital partners, community specialists and skilled nursing facilities. Our vision is ... director. *_Essential Functions_* * * Knowledge regarding current and evolving provider payment methodologies . Reviews and monitors contract/payer performance .… more
- Chiesi (Boston, MA)
- …legislative changes. + Maintain a deep understanding of the distribution, hospital , specialty pharmacy channels; understand pharmacy and hospital capabilities ... and strong understanding with government programs, such as the IRA, 340B, State Medicaid , and Medicare Part D. + Relevant experience with distribution networks, new… more
- Tufts Medicine (Reading, MA)
- …patients treated to promote communication to physicians and to ensure proper reimbursement . 11. Complies with documentation regulations (Medicare, Medicaid , DPH, ... students and evaluates the student's performance. 8. Educates colleagues and hospital employees regarding role of occupational therapy. 9. Contributes to the… more
