The Sr. Claims Auditor utilizes CPT and ICD 10 coding to review physician claims and medical records for coding accuracy. Internal auditing functions focus on "desktop reviews" of claims, design and quality control of future audits, and other auditing related functions. Review clinical notes and claims submitted to verify the appropriateness of codes billed based on servi

improving the quality, cost and experience of health care. Here, we focus on delivering the best patient care, rather than volume. Through innovation and superior care management, we support patients and your well being as a team member. Join a team at the forefront of value based care and discover the meaning behind Caring. Connecting. Growing together. All of us have a

Content Claims Specialist Field Level I Requisition ID 2024 24911 Job Locations US MA Boston Position Type Regular Full Time Category Claims Business Unit CUS_Loss Adjusting US Excellence In Everything We Touch Position Summary The role of Content Claims Specialists is a multi faceted role, which focuses primarily in the following four key areas of edjuster's content clai

Why This Role is Important to Us Commonwealth Care Alliance's (CCA) Clinical Effectiveness (Authorization) Unit is primarily responsible for the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of CCA's benefits plan. The Service Authorization Specialist is responsible

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

Why This Role is Important to Us Commonwealth Care Alliance's (CCA) Clinical Effectiveness (Authorization) Unit is primarily responsible for the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of CCA's benefits plan. The Service Authorization Specialist is responsible

Review assigned accounts by contacting Medicare to ensure timely resolution of accounts. Create updates and document information relating to the financial status of accounts in the hospital billing systems. Contact patients and/or other third party representatives to secure additional information pertaining to reimbursement of accounts. Process rejected/adjusted claims th

Under general supervision of the Follow up Supervisor performs all duties necessary to follow up on outstanding claims and correct all denied claims for a large physician specialty practice. Responsibilities Review all denied claims correct them in the system and send corrected/appealed claims as written correspondence fax or via electronic submission. Identify and analyz

Under general supervision of the Follow up Supervisor performs all duties necessary to follow up on outstanding claims and correct all denied claims for a large physician specialty practice. Responsibilities Review all denied claims correct them in the system and send corrected/appealed claims as written correspondence fax or via electronic submission. Identify and analyz

Under general supervision of the Follow up Supervisor performs all duties necessary to follow up on outstanding claims and correct all denied claims for a large physician specialty practice. Responsibilities Review all denied claims correct them in the system and send corrected/appealed claims as written correspondence fax or via electronic submission. Identify and analyz

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

Financial Assistance Responsible for screening patients for MassHealth, CarePlus, Connector Care, Health Safety Net, assisting in the application process when appropriate. Submits applications all Massachusetts applications for health coverage via the Health Connector. The PBR will keep track of all cases using ONTRAC as well as a paper tickle file system. The PBR will al

Financial Assistance Responsible for screening patients for MassHealth, CarePlus, Connector Care, Health Safety Net, assisting in the application process when appropriate. Submits applications all Massachusetts applications for health coverage via the Health Connector. The PBR will keep track of all cases using ONTRAC as well as a paper tickle file system. The PBR will al

Under general supervision of the Follow up Supervisor performs all duties necessary to follow up on outstanding claims and correct all denied claims for a large physician specialty practice. Responsibilities Review all denied claims correct them in the system and send corrected/appealed claims as written correspondence fax or via electronic submission. Identify and analyz

Under general supervision of the Follow up Supervisor performs all duties necessary to follow up on outstanding claims and correct all denied claims for a large physician specialty practice. Responsibilities Review all denied claims correct them in the system and send corrected/appealed claims as written correspondence fax or via electronic submission. Identify and analyz