- Humana (Boston, MA)
- **Become a part of our caring community and help us put health first** The Claims Review Representative 3 makes appropriate claim decision based on ... procedures, contract provisions, and state and federal legislation. The Claims Review Representative 3...and state and federal legislation. The Claims Review Representative 3 performs advanced… more
- Highmark Health (Boston, MA)
- …position, product development, network options, strategic partnerships, utilization review , local/national client demographics and dentist distribution. Interpret ... added benefits. Meet with all identified practices in assigned territory to review practice financial and quality performance. + Perform effective on-site visits… more
- Commonwealth Care Alliance (Boston, MA)
- …is a subject matter expert in the area of medical policy development and review and works collaboratively with the Sr. Medical Director of Medical Poliy and other ... Coordinate with the Knowledge Hub Team on the annual review of all existing Medical Policies. + Manage the...prior authorization program. + Support the payment policy and claims teams in the development of payment policies, and… more
- LogixHealth (Bedford, MA)
- …internal and external client communications are responded to in a timely manner 3 . Maintain/ensure all client information in CRM coding fields, Master Client Grid, ... up to date by following Coding Policy QA process 4. Execute the Annual Coding Policy Review project/push out all policies to clients for a review and to follow… more