- Humana (Boston, MA)
- …The focus of this role is Medicare Pharmacy and Part D. The Senior Compliance Professional will analyze business requirements, provide research and ... caring community and help us put health first** The Senior Compliance Professional ensures ...Compliance or Health Plan Operations + Familiarity with Medicare pharmacy laws or regulations **Additional Information** Interview Format… more
- Humana (Boston, MA)
- …evaluation of variable factors. We are looking for an experienced Senior Compliance Professional specializing in Medicare Advantage to join our Field ... community and help us put health first** The IFG Senior Compliance Professional ensures ...cross-functional teams, including marketing, operations, and sales, to ensure compliance is integrated into all aspects of Medicare… more
- Cognizant (Boston, MA)
- Cognizant is one of the world's leading professional services companies, we help our clients modernize technology, reinvent processes, and transform experiences, so ... providing recommendations for system and process improvements while ensuring compliance with regulatory guidelines and coordinating issue resolution. **Primary… more
- CenterWell (Boston, MA)
- …part of our caring community and help us put health first** The Senior Strategy Advancement Professional provides data-based strategic direction to identify and ... for business segments or the company at large. The Senior Strategy Advancement Professional work assignments involve...will be responsible for supporting the CenterWell ACO and Medicare payment model programs via the Center for … more
- Humana (Boston, MA)
- …between Humana and its trading partners, Medicare and Medicaid. The Senior Encounter Data Management Professional will work with department leadership, ... caring community and help us put health first** The Senior Encounter Data Management Professional develops business...Medicare . Ensures encounter submissions meet or exceed all compliance standards via analysis of data and develops tools… more
- Prime Therapeutics (Boston, MA)
- …It fuels our passion and drives every decision we make. **Job Posting Title** Senior Compliance Analyst - Remote **Job Description** Job Description The ... Senior Compliance Analyst assists in the implementation...and Ethics Professional (CCEP) or Certified Healthcare Compliance Professional (CHC) + Certified Project Management… more
- Prime Therapeutics (Boston, MA)
- …focus **Reporting Structure** + Reports to Sr Professional , Manager, Director or Senior Director in the Compliance department Potential pay for this position ... and drives every decision we make. **Job Posting Title** Senior Compliance Analyst (Interpretation and Advising) -...and Ethics Professional (CCEP) or Certified Healthcare Compliance Professional (CHC) + Certified Project Management… more
- Prime Therapeutics (Boston, MA)
- …that. It fuels our passion and drives every decision we make. **Job Posting Title** Senior Compliance Analyst - Remote **Job Description** The Senior ... Compliance and Ethics Professional (CCEP) or Certified Healthcare Compliance Professional (CHC) Certified Project Management Professional (PMP)… more
- Humana (Boston, MA)
- …adjustment coding and documentation accuracy. The Clinical Support Team is seeking a senior professional who will be accountable for developing and maintaining ... caring community and help us put health first** The Senior Market Consultation/Partnership Professional interprets, analyzes, and...+ Help ensure accurate review of medical records for Medicare and Medicaid Risk Adjustment + Review and respond… more
- Humana (Boston, MA)
- …a part of our caring community and help us put health first** The Senior Vendor Management Professional works as liaison between vendors and organization. The ... Senior Vendor Management Professional 's work assignments involve...liaison between vendors, internal business owners, contracting, risk, and compliance teams. As part of the Humana Military Contract… more
- Humana (Boston, MA)
- …a part of our caring community and help us put health first** The Senior Contract Management Professional evaluates, drafts, and negotiates contracts and other ... of goods and services for Humana, its subsidiaries and affiliates. The Senior Contract Management Professional work assignments involve moderately complex to… more
- Humana (Boston, MA)
- …community and help us put health first** Humana Healthy Horizons is seeking a Senior Program Delivery Professional to support quality program work in multiple ... Long-Term Services and Supports (LTSS) and Home and Community-Based Services (HCBS). The Senior Program Delivery Professional (LTSS - Quality) works on problems… more
- Humana (Boston, MA)
- …a part of our caring community and help us put health first** The Senior Learning Design Professional uses instructional design, cognitive psychology and adult ... to determine the appropriate solution to a knowledge or performance gap. The Senior Learning Design Professional work assignments involve moderately complex to… more
- Humana (Boston, MA)
- …a part of our caring community and help us put health first** The Senior Inpatient Medical Coding Professional extracts clinical information from a variety of ... data requires an in-depth evaluation of variable factors. **Responsibilities** The Senior Inpatient Medical Coding Professional confirms appropriate diagnosis… more
- Beth Israel Lahey Health (Woburn, MA)
- …at the Beth Israel Deaconess Medical Center (BIDMC), the Revenue Integrity Senior Analyst contributes to Revenue Integrity and Coding oversight at the enterprise, ... **Job Description:** **Primary Responsibilities** * Monitor departments' adherence to professional charge reconciliation, work-queue, and professional coding… more
- CenterWell (Boston, MA)
- …put health first** The Clinical Drug Evaluation and Policy Strategies Senior Clinical Pharmacist Therapeutic Subject Matter Expert monitors drug development ... factors. **Responsibilities** The Clinical Drug Evaluation and Policy Strategies Senior Clinical Pharmacist develops, maintains, and/or operationalizes strategies related… more
- Humana (Boston, MA)
- …relationships with business partners to uphold ethical standards and mitigate risks. The Senior Clinical Compliance Professional will support the Director of ... requires an in-depth evaluation of variable factors. As the Senior Clinical Compliance Professional , you...revenue cycle management (related to billing, coding, collections for Medicare and Medicaid claims) + Experience with Auditing and… more
- Dana-Farber Cancer Institute (Brookline, MA)
- … programs that adhere to regulations and industry standards, focusing on hospital and professional billing compliance . The Director acts as the 'second line of ... discrepancies. Develops and implements monitoring systems and metrics to ensure ongoing compliance . Prepares and presents review findings to senior management… more
- CenterWell (Boston, MA)
- …as a backup to divisional regulatory staff on issues of regulations, coverage, compliance and documentation. + Reviews records and operations as requested regarding ... compliance with policy and payer requirements. + Responsible for...Registered Nurse or Physical Therapist. + 5 years of professional experience in Home Care, 2 years of which… more
- CenterWell (Boston, MA)
- …non-technical audiences. **Preferred Qualifications** + Master's degree + Experience in senior -focused or Medicare Advantage care models, especially within ... + Define and track KPIs to measure product success, communicate progress to senior leadership, and adapt to evolving priorities. + Ensure compliance with… more