Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world's leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable

The FH authorization process is an essential function to FH's compliance with CMS regulations, NCQA standards, other applicable regulatory requirements, and customer expectations. The FH Authorization Coordinator serves to administer the FH prior authorization process as outlined in the Plan Member Handbook/Evidence of Coverage, departmental policies and procedures, and r

1. Elicits data and reporting requirements from hospital leadership, clinicians, and other staff, using interviews, document analysis, requirements workshops, site visits, use cases, scenarios, data analysis, task, and workflow analysis. 2. Queries and analyzes data from hospital systems such as our electronic medical record system (Epic), enterprise data warehouse (EDW),

From the very start, Bright Horizons' founders believed that doing well was firmly intertwined with doing good. That mission was formalized in 1999 when the company created the Bright Horizons Foundation for Children. Since then, the organization has provided the framework and the support for employees, clients, vendors, families, and friends to leverage our early learnin

At Boston Children's Hospital, the quality of our care and our inclusive hospital working environment lies in the diversity of our people. With patients from local communities and 160 countries around the world, we're committed to reflecting the spectrum of their cultures, while opening doors of opportunity for our team. Here, different talents pursue common goals. Voices

Reporting directly to the Finance Department, the successful candidate will be responsible for coordinating insurance activities, analyzing insurance data, ensuring compliance with regulations, and fostering effective communication between internal and external stakeholders. This role will report directly to the Controller and will interact with third party insurance brok

Manage incoming Bordereaux from program managers Review and ensure Bordereaux submitted have accurate template format Complete review of validation errors from Bordereaux ingestion, follow up with individual program managers for correction Ensure and maintain accurate data within the LOC, written and affiliate Bordereaux trackers Manage the LOC process Manage OFAC check p

Under the general direction of PFC Manager, the Outpatient Financial Counselor (OPFC) has a dual role to help vulnerable BMC patients to access healthcare coverage and to preserve and protect BMC revenue by securing payors to reduce uncompensated care. The OPFC serves as an advocate and navigator, assisting low income, uninsured and underinsured patients apply for financi

Prior Authorization Specialist hybrid after onsite training! Full Time 8am 4 30pm Job Ref 29384 Category Clerical & Administrative Support Location Emerson Hospital, 133 Old Road to Nine Acre Corner, Concord, MA 01742 Department Patient Access Schedule Full Time Shift Day shift Hours 8 00 4 30 Job Summary Reports to the Direct of Patient Access, the position serves as the

Insurance Coordinator is responsible for proactive management of the insurance authorization process. Supports clinicians by managing insurance authorizations/certifications (initial/ongoing) process. Assists patients with the financial and authorization issues related to their care. Supports all ambulatory PT/OT practice sites. Proactively, effectively and efficiently ma

Under the direction of the Associate Director, reviews medical record documentation to identify pertinent diagnoses and/or procedures that require coding. The Certified Professional Coder reviews medical records to assure accurate specificity of diagnoses, procedures, and appropriate reimbursement for professional and/or facility charges. Effectively utilizes ICD 10, CPT,

Under the direction of the Associate Director, reviews medical record documentation to identify pertinent diagnoses and/or procedures that require coding. The Certified Professional Coder reviews medical records to assure accurate specificity of diagnoses, procedures, and appropriate reimbursement for professional and/or facility charges. Effectively utilizes ICD 10, CPT,

What does a Prior Authorization Specialist do? The Prior Authorization Specialist (PAS) is an essential role responsible for facilitating exceptional patient experience, by securing authorizations for all scheduled services related to medical and surgical admissions across entities, including BWH OR procedures, BWFH OR procedures, FXB OR procedures and BWH/BWFH Endoscopy

Are you a current UMass Memorial Health caregiver? CLICK HERE to apply through your Workday account. Schedule Details Monday through Friday Scheduled Hours 0800 1630 Shift 1 Day Shift, 8 Hours (United States of America) Hours 40 This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process. Everyone