The Regulated Claims Settlement Coordinator supports the Claims Settlement Team through leading the review and response to disputed claims submitted through state and federal arbitration processes. The Regulated Claims Settlement Coordinator will be responsible for supporting Zelis' settlement offers and pricing after disputes have been filed to federal and state arbitrat

Assists members of the Insurance Operations Department by completing a wide variety of assignments that involve technical complexity. Demonstrates a solid understanding of procedures and ability to produce timely high quality work. Essential Functions Collects, analyzes, and maintains data relating to specific accounts and claim trends. Conducts day to day processing acti

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

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

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

Process provider applications and revalidation applications through verifications, credentialing, and site visits Accurately input enrollment data into database system Conduct quality assurance functions to reduce errors and improve processes and performance Demonstrate great depth of knowledge / skills in own function and act as a technical resource to others Educate and

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),

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

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

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

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,

Employer DWS Group Title Insurance Advisory Senior Relationship Manager Location Boston, NYC, Chicago or other DWS office location Job Code #LI LV1 #LI 04 About DWS Today, markets face a whole new set of pressures but also a whole lot of opportunity too. Opportunity to innovate differently. Opportunity to invest responsibly. And opportunity to make change. Join us at DWS,