• 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
    DirectEmployers Association (10/17/25)
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  • 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
    DirectEmployers Association (10/18/25)
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  • 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
    DirectEmployers Association (10/17/25)
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  • Medicaid Provider Hospital

    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 (10/21/25)
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  • Medicare (PPS) Provider Hospital

    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
    Humana (10/18/25)
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  • Director, Provider Relations

    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 (10/18/25)
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  • Provider Contracting Professional 2

    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
    Humana (10/17/25)
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  • Senior Provider Contracting Professional

    Humana (Boston, MA)
    …Senior Provider Contracting Professional initiates, negotiates, and executes physician, hospital , and/or other provider contracts and agreements for an ... + 2+ years of network management experience including but not limited to: provider and hospital contracting, network administration in a healthcare company or… more
    Humana (10/15/25)
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  • Director, Net Revenue

    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
    Beth Israel Lahey Health (09/08/25)
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  • Inpatient Medical Coding Auditor

    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
    Humana (09/24/25)
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  • Intake Coordinator

    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
    BrightSpring Health Services (09/09/25)
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  • RN Case Manager - Inpatient Case Management SH

    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 (09/25/25)
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  • RN Case Manager - Inpatient Case Management

    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
    Cambridge Health Alliance (09/03/25)
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  • Patient Care Technician - PCT - Training Provided

    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
    Fresenius Medical Center (10/07/25)
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  • Patient Care Technician - PCT - Training Provided

    Fresenius Medical Center (Chelsea, 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 (10/01/25)
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  • Nurse Audit Manager

    Humana (Boston, MA)
    …ensure medical documentation and coding are precise, compliant, and support optimal reimbursement . This is an exciting opportunity to apply your advanced technical ... Applies clinical and coding experience to conduct reviews of provider codes and billing. + Decisions are typically related...or more years of clinical RN experience in a hospital setting. + 3 or more years of experience… more
    Humana (10/18/25)
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  • RN Case Manager - Inpatient Case Management SH

    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
    Cambridge Health Alliance (10/04/25)
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  • Senior Managed Care Analyst

    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
    Atrius Health (09/02/25)
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  • Lead, Trade and Channel, Patient Services, Global…

    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
    Chiesi (09/18/25)
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  • Medical Equipment Implementation Specialist…

    Philips (Cambridge, MA)
    …Philips Biomed/Clinical Engineering program which includes Centers for Medicare & Medicaid Services (CMS), FDA and accreditation agencies. + Drive new initiatives ... in an office/home office and/or remote setting, as well as in a hospital /healthcare environment; adhere to requirements. + Work flexible hours (based on business… more
    Philips (10/21/25)
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