Medicare Advantage and DSNP Claims Analyst - Somerville, MA

The Claims Analyst under the direction of the Manager of PACE Claims is responsible for overall claims adjudication insurance validation process.This includes auditing adjudicated claims ensuring payments made in accordance with their contracts analyzing claims data for trends re ...

The Claims Analyst under the direction of the Manager of PACE Claims is responsible for overall claims adjudication and insurance validation process. · Maintaining up-to-date knowledge of fee schedules for both Medicare and MassHealth. · Auditing adjudicated claims to ensure paym ...

We are seeking multiple Claims Business Analysts with strong healthcare data expertise to support the analysis, integration and validation of claims and wellness data. · Analyze medical dental pharmacy vision and wellbeing claims data to identify trends discrepancies and processi ...

Job summary · Process pending unclaimed property claims that are received by the Division. · ...

The Office of the Massachusetts State Treasurer and Receiver General is seeking a Claims Analyst I to process pending unclaimed property claims. · The successful candidate will provide independent initial approval for all valid claims in a timely fashion, research the status of p ...

This role involves extracting knowledge and insights from data to investigate business/operational problems using various techniques. Key responsibilities include collecting and analyzing Medicare Advantage claims data to ensure timeliness accuracy compliance; reviewing tracking ...

The Claims and Credentialing Analyst will be a pivotal role in analyzing and coordinating all activities of the Provider Data team by evaluating and refining processes,,conducting comprehensive data analysis,,and ensuring compliance with all applicable State,CMS(contractual guide ...

Epic PB/PB Claims Install Analyst residing on the Epic Install Billing Teams. · 5–15 years of Epic PB build or PB Claims experience · Certifications Required: Epic Resolute Professional Billing Administration and Epic Resolute Claims · ...

+The Professional Billing Claims Analyst III position will be housed under a subsidiary organization of C3, Community Technology Cooperative, LLC (CTC). To implement, maintain support and maximize the use of clinical financial and administrative portions of the software applicati ...

The Professional Billing Claims Analyst III position will be housed under a subsidiary organization of C3, Community Technology Cooperative, LLC (CTC). To implement, maintain, · support, · and maximize the use of clinical, · financial, · and administrative portions of the softwar ...

Join our IT team as a Healthcare Claims Analyst and bridge clinical concepts with technical expertise to deliver accurate demographic eligibility and claims data for vulnerable populations. ...

We're looking for a Healthcare Claims Analytics Analyst to join our IT team and play a pivotal role in delivering accurate, high-quality demographic, eligibility, and claims data. · Data collection and preprocessing of complex healthcare datasets. · Analyze incoming data from hea ...

We're looking for a Healthcare Claims Analytics Analyst to join our IT team and play a pivotal role in delivering accurate, high-quality demographic, eligibility, and claims data. · In this role, you'll bridge clinical concepts with technical expertise, · transforming complex da ...

This position manages complex claims with special emphasis on high dollar and litigated claims. Ensures compliance with state laws and company policies along with mentoring assigned Analysts regarding basic claims standards and department policies. · Provides professional, techni ...

This role focuses on the design, development and implementation of IT solutions to meet organizational needs through new and existing applications. · Designs, develops, implements and updates internal IT applications in accordance with specifications and business needs. · Designs ...

This role focuses on the design, development and implementation of information technology (IT) solutions in order to meet the organization's needs through new and existing applications, systems architecture, network systems and applications infrastructure and the management of th ...

Mass General Brigham relies on a wide range of professionals to advance its mission. The Fraud Analyst builds data analytics for MGB Health Plan's Special Investigations Unit; this role uses data analytics for the SIU to find fraud leads. · Job Summary · The role will create anal ...

Responsible for overseeing a team that assesses healthcare claims for accuracy, compliance, and eligibility, · ensuring that claims are processed efficiently and in accordance with industry standards, regulatory requirements, · and organizational policies. This position will guid ...

Responsible for overseeing a team of 4-5 employees that assesses Medicare claims for accuracy, · compliance, · and eligibility ensuring that claims are processed efficiently · and in accordance with industry standards regulatory requirements · and organizational policies. · This ...

Responsible for overseeing a team of claims reviewers to ensure accurate and timely healthcare claims processing. · -Supervise and manage a team of claims reviewers to ensure accurate and timely healthcare claims processing. · -Oversee claims review and analysis to ensure compl ...