- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …the creation of controls to manage fraud, waste and abuse schemes. + Support the Medicare compliance program by overseeing Medicare fraud waste and abuse ... Prevention (FIP) Unit including management of a team of senior managers, data analysts, fraud investigators, certified coders and...on fraud waste and abuse work, present to the Medicare Compliance Committee and manage requests and… more
- Commonwealth Care Alliance (Boston, MA)
- …Department Regulatory Affairs and Compliance infrastructure at CCA. + Promote compliance in CCA's business operations with all Medicare and Medicaid ... Program + Contribute towards the maintenance and enhancement of an effective Compliance Monitoring Program + Contribute towards the maintenance and enhancement of an… more
- WellSense (Boston, MA)
- Senior Manager of Clinical UM - BH...Department on issues that have both legal risk and compliance aspects. + Partners with the Accreditation Manager ... that works for our members, no matter their circumstances. **Job Summary:** The Senior Manager of Clinical Utilization Management (UM), Behavioral Health is… more
- Prime Therapeutics (Boston, MA)
- …depth perception and ability to adjust focus **Reporting Structure** + Reports to Manager or Sr Director in the Finance department **Responsibilities** + 3+ ... and drives every decision we make. **Job Posting Title** Senior Financial Analyst - Remote **Job Description Summary** This...and resolving complex problems and issues. + If supporting Medicare Part D, will be responsible for implementing CMS… more
- Point32Health (Canton, MA)
- …Analytics and other members of the Network & Provider Analytics team, the Senior Manager will lead the analytic support of contract negotiations, strategic ... and mentoring to all members of the team. The Senior Manager will directly support complex analysis...adequacy across all lines of business in accordance with compliance and regulatory requirements. Additionally, will lead analysts in… more
- HealthEdge Software Inc (Boston, MA)
- **Overview** **Position** **Overview:** As a Senior Product Manager , within theclaimsvalue stream forHealthRulesPayor, you will have ownership of system ... **: ** + 5+ years' experience as a product manager in a **SaaS-based, Agile** /Scrum technology company including...or healthsystem + Experience with government plans/program such as Medicare , Medicaid, Duals + Master's degree in Business or… more
- Commonwealth Care Alliance (Boston, MA)
- …the direction of the Sr . Director, TPA Management and Claims Compliance , Medical/BH Reimbursement Policy Manager will have overall responsibility for CCA's ... and Behavioral Health reimbursement policies for statewide impact. The Policy Manager is responsible for managing cross-departmental implementation of changes to… more
- HealthEdge Software Inc (Boston, MA)
- **Overview** **Position Overview** **:** As aSenior Manager ,Product ManagementforHealthEdgeSource, you willbededicatedto developing innovative solutions for the ... payment integrity, and enterprise level. Our Reimbursement Transformation features Medicare and Medicaid content coupled with flexible contract configuration… more
- Humana (Boston, MA)
- …a part of our caring community and help us put health first** The Senior Vendor Management Professional will work as liaison between vendors and Humana supporting ... areas while helping ensure vendors meet contractual obligations as part of the Medicare Prescription Payment Plan program. The M3P program will provide all … more
- Beth Israel Lahey Health (Boston, MA)
- …with any changes in ICD-10 and CPT-4 coding and remains current with Medicare , federal insurance and third party billing compliance regulations. Works ... codes including the appropriate use of modifiers to ensure compliance for reimbursement. **Job Description:** **Essential Responsibilities:** 1. Coordinates coding… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …of Trustee approved goals and regulatory and standard setting agencies. The Risk Manager performs as an internal compliance consultant by maintaining current ... The Risk Manager is a member of the Patient Safety...level of quality care to the patients, ensuring regulatory compliance and mitigating malpractice risk through loss prevention. The… more
- Commonwealth Care Alliance (Boston, MA)
- …Role is Important to Us:** **Position Summary:** Reporting to the Chief Risk, Compliance & Ethics Officer, the Vice President, Chief Privacy & Security Officer ... oversight, auditing, monitoring, and ongoing operation of CCA's privacy and security compliance assuring that it meets all requirements of applicable federal and… more
- Elevance Health (Woburn, MA)
- …member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services ... National Government Services (NGS) and sits on the NGS Senior Leadership Team, reporting directing to the federal business'...reporting directing to the federal business' Chief Legal and Compliance Officer. **How you will make an impact:** +… more
- Point32Health (Canton, MA)
- …be expected to develop conclusions based on data findings under guidance from the Manager . The Analyst will also create project plans and ensure that the product ... research and internal data to analyze market and product data across all Medicare market segments in all states to develop strategies to enhance existing products… more
- State of Massachusetts (Boston, MA)
- …as well as other state and federal entities such as the Centers for Medicare and Medicaid Services, State Auditor's Office, and Office of Inspector General. The ... and abuse, including identification and implementation of best practices, reporting compliance , claims data analysis, development of key performance indicators, and… more