- Bear Mountain Health Care (MA)
- …Home Medicaid EXPERT? Bear Mountain Healthcare is currently seeking a full time Medicaid Pending Specialist to assist in the completion of Medicaid ... facilities in Massachusetts. Duties include: . Responsible for working Pending Medicaid applications and re-determinations in order to ensure financial eligibility.… more
- Point32Health (Canton, MA)
- …of the Director, Customer Experience, the Member Advisory Committee Specialist is responsible for helping Point32Health understand, and meaningfully improve, ... the experiences our members have with us. The Member Advisory Committee Specialist is directly responsibility for ensuring all Member Advisory Committee obligations… more
- Brockton Hospital (West Bridgewater, MA)
- …Under the general direction of the Coding Compliance Manager the Outpatient Coding Specialist is responsible for coding and abstracting services for the full range ... with coding rules and regulations according to regulatory agencies for state Medicaid plans, Center for Medicare Services (CMS) Office of the Inspector General… more
- Prime Therapeutics (Boston, MA)
- …our passion and drives every decision we make. **Job Posting Title** MTM Specialist Sr **Job Description** The Senior Medication Therapy Management (MTM) Service ... Specialist will act as a Subject Matter Expert for...targeted population; for Medicare, is Centers for Medicare & Medicaid Services (CMS) compliant + Act as a Subject… more
- East Boston Neighborhood Health Center (East Boston, MA)
- …Patient Accounts All Locations: 151 Orleans Street Position Summary: The Billing Specialist II is responsible for organizing work flow to complete the timely ... and accurate submission of medical and dental claims to Medicaid , Medicare, other third party payors and patients. This...and maintain a low backlog of work. The billing specialist III works as part of a team that… more
- Commonwealth Care Alliance (Boston, MA)
- …facilities under the provisions of CCA's benefits plan. The Service Authorization Specialist is responsible for providing accurate, prompt, and appropriate entry of ... Providers for services needing prior authorization. The Service Authorizations Specialist reports to the Service Authorization Intake Manager. Supervision Exercised:… more
- ManpowerGroup (Marlborough, MA)
- …_healthcare solutions & biomedical manufacturing industry,_ is seeking a **Pre-Authorization Specialist ** to join their team.This position is a **6-Month Contract** ... to work efficiently in a fast-paced environment. **Job Title:** Pre-Authorization Specialist **Location:** Fully Remote, EST Time Zone **Pay Range:** $25.20/hour +… more
- Children's Hospital Boston (Boston, MA)
- …Week:40 Job Posting Category:External RelationsJob Posting Description:This Government Relations Specialist (Federal) will be responsible to: + Coordinate the ... the impact of policies on specific populations (eg, children on Medicaid , children with chronic healthcare conditions). Provide legislative and administrative… more
- Cardinal Health (Boston, MA)
- …center or customer service environment, preferred + Clear knowledge of Medicare, Medicaid & Commercial payer policies and guidelines for coverage, preferred + ... Knowledge of Diagnostic Medical Expense and Medicare Administrative Contractor practices, preferred + Clear understanding of Medical, Supplemental, and pharmacy insurance benefit practices, preferred + Excellent written and oral communication, mediation, and… more
- Fallon Health (Worcester, MA)
- …be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid , and PACE (Program of All-Inclusive Care for the Elderly)- in ... the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn. **Brief Summary of purpose:** Respond to physician, hospital, ancillary provider inquiries and requests for services associated with the resolution of provider… more
- Prime Therapeutics (Boston, MA)
- …management. Enforces teamwork across all internal departments, as well as with Medicaid Clients, and an in-depth understanding of all rebate programs, trends, and ... state laws and standards of practice which govern the Medicaid Drug Rebate Program. + Ensures compliance with each...department are achieved. + Works with Quality and Training specialist to refine and improve any processes that effect… more
- Commonwealth Care Alliance (Boston, MA)
- …the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for conducting centralized clinical review and authorization creation ... * Maintain up-to-date knowledge of and compliance with CMS, NCQA and state Medicaid requirements. * Lead preparation for internal and external audits (eg CMS Program… more
- Boston Public Schools (Boston, MA)
- …resolution meetings, hearings, and mediation settlement meetings as needed + Medicaid reimbursement activities (Parent Consents, Random Moments, EasyTrac) + Perform ... Alternative Learning Environment Special Education, Autism Special Education, Behavior Specialist / EBD Special Education, Consulting Teacher Special Education,… more
- Fallon Health (Worcester, MA)
- …be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid , and PACE (Program of All-Inclusive Care for the Elderly)- in ... with the member, the Clinical Integration team, and Primary Care Providers, Specialist and other community partners, to ensure a cost effective quality outcome… more
- Cardinal Health (Boston, MA)
- …skills and prioritizes getting the right things done. **The Accounts Receivable Specialist II is responsible for processing insurance claims and billing. They will ... with secondary insurance company when necessary. + Bills supplemental insurances including all Medicaid states on paper and online. + Mails all paper claims. + Acts… more
- Fallon Health (Worcester, MA)
- …be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid , and PACE (Program of All-Inclusive Care for the Elderly)- in ... errors and recommends improved processes and/or training needs. Meets with Provider Specialist staff monthly to review error trends and collaborate solutions for… more
- Evolent (Boston, MA)
- …Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your expertise in interventional cardiology to help ensure the ... or sanction by any state or federal health care program, including Medicare or Medicaid , and is not identified as an "excluded person" by the Office of Inspector… more
- Beth Israel Lahey Health (Boston, MA)
- …and oversight of a team of specialty pharmacy liaison's, medication access specialist and patient assistance program coordinators. This individual will also work ... accuracy. (essential) 9. Monitors situations for fraud, waste, and abuse of Medicare/ Medicaid benefits and reinforces HIPAA and PHI protocols. (essential) 10. Has… more