- Commonwealth Care Alliance (Boston, MA)
- …relations for Commonwealth Care Alliance's SCO and One Care lines of business . This role is responsible for cultivating high-impact relationships with key healthcare ... team. Cross-Functional Collaboration - Work closely with network contracting, credentialing, claims , IT, customer service, compliance, and quality teams to address… more
- Commonwealth Care Alliance (Boston, MA)
- …dashboards and tools. **Education (Required)** + Bachelor's Degree in information systems or related quantitative field required ( Business , Computer Science, ... 011330 CCA-Clin Operations & Implementation **_This position is available to remote employees residing in Massachusetts. Applicants residing in other states will not… more
- Commonwealth Care Alliance (Boston, MA)
- 081730 instED-Information Technology **_This position is available to remote employees residing in Massachusetts. Applicants residing in other states will not be ... 21st century! The Data Science Manager at instED is a clinical/ business -facing and technical-facing role that collaborates with clinical/ business stakeholders… more
- Insight Global (Woonsocket, RI)
- Job Description Insight Global is seeking a business systems analyst to sit in Hartford, CT or fully remote but work east coast time zone. This person would ... systems that process close to 1 million in claims a day. Key Responsibilities Include: * Elicit and...day. Key Responsibilities Include: * Elicit and document detailed business and system requirements. * Manage and resolve open… more
- Humana (Boston, MA)
- …understanding of Humana processes, as well as a focus on collaborative business relationships, value-based care, population health, or disease or care management. ... products, or other medical management organizations, hospitals/ Integrated Delivery Systems , health insurance, other healthcare providers, clinical group practice… more
- Prime Therapeutics (Boston, MA)
- …Title** Sr. AI Business Analyst - Remote **Job Description** **Are you a Business Systems Analyst with an AI background? We are standing up a new AI ... the requirements for changes to Prime's claims systems . **Responsibilities** + Ensure understanding of business ...within project + Educate and advance business systems analyst practice within the Claims IT… more
- GovCIO (Boston, MA)
- …Skills and Experience** + Bachelor's degree in engineering, Computer Science, Systems , Business or related scientific /technical discipline or equivalent ... testing strategy, planning, and execution across a portfolio of healthcare systems , ensuring compliance with regulatory standards and delivery of high-quality,… more
- Cognizant (Boston, MA)
- …with Medicare, Medicaid, and third-party guidelines. . Effectively document and log claims /appeals information on relevant tracking systems . Utilize critical ... determination We strive to provide flexibility wherever possible. Based on this role's business requirements, this is a remote position open to qualified… more
- Cognizant (Boston, MA)
- …, you will make an impact by leading the configuration and optimization of QNXT systems to support healthcare claims processing and reimbursement. You will be a ... to provide flexibility wherever possible. Based on this role's business requirements, this is a ** remote position**...you stand out:** + Experience with NetworX / QCS systems . **Salary and Other Compensation:** Applicants will be accepted… more
- Beth Israel Lahey Health (Charlestown, MA)
- …back-end billing functions and workflows, charge generation and capture, claims generation and reconciliation, remittance posting processes, retro adjudication and ... router actions, this position requires an advanced-level knowledge of professional business office operational workflows, policies and procedures and expertise in… more
- EPAM Systems (Boston, MA)
- …of end-to-end testing for major pharmacy technology programs. You'll bridge business , product, and technology teams, ensuring high-quality, compliant solutions that ... architects to define project scope, dependencies, and risks + Collaborate with business and product experts to capture requirements and translate them into E2E… more
- Molina Healthcare (Boston, MA)
- …email, and off phone work supporting our Medicaid, Medicare and/or Marketplace business . * Conduct varies surveys related to health assessments and member/provider ... member eligibility and covered benefits, Provider Portal, and status of submitted claims . * Ability to effectively communicate in a professionally setting. **Job… more
- Highmark Health (Boston, MA)
- …supporting the Epic Resolute Hospital Billing application. Responsibilities include business / systems analysis, requirements definition and documentation, system ... provide standardized, comprehensive workflows. Corrects issues, conducts routine maintenance, updates systems with new functionality to meet the end user's needs,… more
- Humana (Boston, MA)
- …facilities. They will work closely with IT, the pricing software vendor, CIS BSS, claims operations, and other business teams involved in the administration of ... The Medicare (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business Intelligence Engineer will be an integral part of the Pricer Business… more
- Cardinal Health (Boston, MA)
- ** Remote Hours: Monday - Friday, 7:00 AM - 3:30 PM PST (or based on business need)** **_What Accounts Receivable Specialist contributes to Cardinal Health_** ... is responsible for verifying patient insurance and benefits, preparing and submitting claims to payers, correcting rejected claims , following up on unpaid… more
- Humana (Boston, MA)
- …reduction, by increasing the accuracy of provider contract payments in our payer systems , and by ensuring correct claims payment. Begins to influence ... anomalies in data to identify and collect overpayment of claims . Contributes to the investigations of fraud waste and...**Use your skills to make an impact** **WORK STYLE:** Remote /Work at Home. While this is a remote… more
- Zurich NA (Boston, MA)
- …General Liability and Commercial Auto personal injury cases. At Zurich North America Claims we acknowledge that work life-balance and flexibility are a priority when ... Designed with our employees' needs in mind, the ZNA Claims hybrid work model emphasizes flexibility, allowing claims...have strong computer skills and be able to handle remote team-based work which requires them to use video… more
- Commonwealth Care Alliance (Boston, MA)
- …relations for Commonwealth Care Alliance's SCO and One Care lines of business . This role is responsible for cultivating high-impact relationships with key healthcare ... team. Cross-Functional Collaboration * Work closely with network contracting, credentialing, claims , IT, customer service, compliance, and quality teams to address… more
- Humana (Boston, MA)
- …reduction, by increasing the accuracy of provider contract payments in our payer systems , and by ensuring correct claims payment and appropriate diagnosis ... an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a...**Use your skills to make an impact** **WORK STYLE:** Remote /work at home. While this is a remote… more
- Insight Global (Stoughton, MA)
- …Provide phone support to patients by navigating a variety of pharmacy dispensing systems to adjudicate claims , refill medications, and increase adherence in ... is looking for Prior Authorization Technicians to work fully remote in support of one of our large healthcare...systems to input data, perform adjudication on test claims and prepare action plans for follow-up. * Effectively… more
