- Point32Health (Watertown, MA)
- …the general direction of the Member Appeals and Grievance Supervisor the Appeals and Grievance Analyst is responsible per State and Federal regulations for ... the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works… more
- Highmark Health (Boston, MA)
- …of a grievance/appeal; documents, investigates, refers and coordinates grievances and appeals ; initiates a case file for each grievance and appeal; ensures ... all involved parties. + Participate in workgroup meetings to address trends in appeals and grievances and to work on process improvement initiatives with cross… more
- Evolent (Boston, MA)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** ** Analyst , Client Analytics** Integrate and analyze claims and enrollment data from multiple ... Evolent's clinical services (ie, specialty care, utilization management, care management, appeals & grievances) + Using analytical tools to integrate various data… more
- Intermountain Health (Boston, MA)
- …updates to charging/coding/NCCI regulations and/or errors, and regarding audits and appeals , to facilitate corrective action planning for improved processes. 7. ... Complies with all CMS, Federal and State regulations, and payor guidelines, and ensures consistent and compliant application with charge/coding capture, charge editing, and audit and reimbursement practices. Researches and collaborates on regulation updates to… more
- Commonwealth Care Alliance (Boston, MA)
- …to the Director, Claims Operations and Quality Assurance, the Claims Sr. Analyst plays a critical role in ensuring accurate, compliant, and timely reimbursements ... issues - including underpayments, overpayments, and disputes. The Claims Sr. Analyst serves as a subject matter expert on Medicaid (MassHealth), Medicare,… more
- Intermountain Health (Boston, MA)
- **Job Description:** The HIM Coding Audit Training Analyst Coordinator provides advanced training to hospital coding staff, compliance, CDI, physicians, and clinical ... providers, clinical staff, compliance and the CDI team. + Audits and creates appeals for all payer and regulatory denials and downgrades and provides in-depth coding… more