- Commonwealth Care Alliance (Boston, MA)
- … Claims Sr. Analyst serves as a subject matter expert on Medicaid (MassHealth), Medicare , and commercial payment methodologies and supports audit, compliance, ... 011250 CCA- Claims **Position Summary:** Reporting to the Director, ...and timely reimbursements within the scope of MassHealth and Medicare Advantage programs. Under the direction of the Director… more
- 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 ... Coding Sr. Analyst will be responsible for developing prospective claims auditing and clinical coding and reimbursement ...new CPT and HCPCS codes for coding logic, related Medicare / Medicaid policies to make recommend reimbursement… more
- Humana (Boston, MA)
- …The Senior Business Intelligence Engineer will develop and maintain expertise in Medicaid reimbursement methodologies rooted in complex grouping concepts (EAPG, ... Business Intelligence Engineer will be responsible for: + Researching state-specific Medicaid reimbursement methodologies for hospitals and facilities +… more
- Intermountain Health (Boston, MA)
- …in Medicare , Medicaid , and/or governmental reporting + Experience with Medicare and Medicaid reimbursement world and cost reports. + Experience ... and exception requests to appropriately maximize reimbursement . Interacts with Medicare Administrative Contractor, State Medicaid , and hospital personnel as… more
- Amgen (Boston, MA)
- …information to HCPs on how the products are covered under the benefit design (Commercial, Medicare , Medicaid ) + Serve as a payer expert for defined geography and ... the lives of patients while transforming your career. **Field Reimbursement Manager - Boston, MA** **What you will do**...of medical insurance terminology + Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and… more
- Otsuka America Pharmaceutical Inc. (Boston, MA)
- …+ Educate HCPs and their staff on matters related to access, coverage, reimbursement processes, claims submissions, and coding requirements + Analyze payer ... **Position Summary** The Field Reimbursement Manager (FRM) serves as the subject-matter expert...in rare disease + Strong knowledge of Centers for Medicare & Medicaid Services (CMS) policies and… more
- Otsuka America Pharmaceutical Inc. (Boston, MA)
- …compliance and risk management Preferred Skills + Comprehensive knowledge of Medicare , Medicaid , and commercial insurance reimbursement regulations ... Director of Field Reimbursement Management (FRM) Position Overview We are seeking...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- WellSense (Boston, MA)
- …Experience with Behavioral Health providers preferred** + Experience with Commercial, Medicare and Medicaid reimbursement methodologies + Understanding ... health insurance company serving members across Massachusetts and New Hampshire through Medicare , Individual and Family, and Medicaid plans. Founded 25 years… more
- Fresenius Medical Center (Waltham, MA)
- …up teams to assure proper direction is obtained. + Assuring compliance with Medicare / Medicaid requirements and regulations by: + Maintaining current knowledge on ... + Reviewing and monitoring routine follow-up activities of unpaid claims team for effectiveness; setting performance measurements to improve... Medicare , Federal, State and local regulations including … more
- Cardinal Health (Boston, MA)
- …done. **The Accounts Receivable Specialist II is responsible for processing insurance claims and billing. They will work within the scope of responsibilities as ... and support from AR & Billing leadership teams.** **_Responsibilities_** + Processes claims : investigates insurance claims ; and properly resolves by follow-up &… more
- Cardinal Health (Boston, MA)
- …as required, necessary, or appropriate. + Acts as a subject matter expert in claims processing. + Processes claims : investigates insurance claims ; properly ... optimal account receivables performance and client satisfaction. + Resolves complex insurance claims , including appeals and denials, to ensure timely and accurate … more
- East Boston Neighborhood Health Center (East Boston, MA)
- …work flow to complete the timely and accurate submission of medical and dental claims to Medicaid , Medicare , other third party payors and patients. ... Duties: + Helps ensure the accuracy and completeness of claims submitted to payors and bills submitted to patients....are being met. Reads and understands third party payor reimbursement regulations and updates and works with PFS Leadership… more
- Humana (Boston, MA)
- …and well-grounded medical coding auditor to quality review the inpatient hospital claims for proper reimbursement , handle provider disputes in a result-oriented ... efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large.… more
- Cognizant (Boston, MA)
- …schedules, and benefits configuration. + Knowledge of health plan operations for Medicare , Medicaid , Marketplace, LTSS, DSNP (duals) is highly preferred ... IT and business teams to design, implement, and maintain provider reimbursement configurations, contract loading, and pricing methodologies within NetworX. + Conduct… more