OF MINIMUM QUALIFICATIONS Education and/or experience equivalent to a bachelor's degree in science, or related field. Four (4) years of clinical data management experience. Knowledge of clinical trials data processing concepts. Demonstrated knowledge of data management processing systems. Demonstrated experience in all areas of data management database build, database main

The Certified Edit Dispute Resolution Analyst will be responsible for researching and auditing medical records for complex, diverse, multi specialty provider claims to identify and determine appropriately coded billed services when compared to the Zelis Claim Edits Product. The Certified Edit Dispute Resolution Analyst demonstrates an understanding of Zelis edits as an in

Uses electronic tracking systems to thoroughly document progress in all tasks, including retrieval of pertinent patient materials. Uses standard processes and protocols to monitor and follow up with patients, hospitals, and other parties on materials status. Collaborates with fellow Records Specialists and New Patient Coordinators to ensure seamless coverage and task mana

Medical Biller Opportunity Full Time, Onsite Pembroke Hospital is seeking Full Time Medical Biller to join our team. This is a on site position. Pembroke Hospital is a 120 bed acute care, inpatient behavioral health facility located south of Boston, in Pembroke, MA. Situated on 26 acres, we offer inpatient and partial hospitalization treatment to teens, adults and older a

The LPN/LVN is responsible for clinical functions on the unit, including all aspects of patient care incorporating the nursing process in accordance with the applicable Nurse Practice Act. The staff LPN/LVN shall ensure that the unit to which assigned shall function in a smooth, organized, and efficient manner as directed by the Registered Nurse. The provision of care inc

1. Quality 0= 1.1 Achieve and maintain a Department registration information completeness/accuracy of 95% as defined and measured on the individual work plan. 2. Support customer satisfaction initiatives as defined in the annual individual work plan. 2.1 External Customers (Patients, Families, Guests, Visitors) 3. Finance. 0= 3.1 Facilitate Time of Service (TOS) Collectio

Clinical Informaticist, MGB Solutions Delivery, Office of the CMIO Reporting to the Brigham CMIO, The Clinical Informaticist serves as a liaison and builds collaborative relationships between informatics teams, clinicians, digital systems teams, and operational staff to ensure the optimum design/use of clinical software and workflows for patient safety, quality, patient e

Review pre bill cases simultaneously with a physician during each work shift excluding breaks and meetings to analyze and validate diagnosis and procedure codes for inpatient services via coding compliance and clinical knowledge to support accurate DRG assignment Utilizes Accuity technology for tracking of coding errors, query opportunities and other data collection as ne

Telecommute within Boston, MA/Fortune 5 Company/Excellent Compensation Package!

Assess the clinical indicators and suggestions of various query requests received from the MD Reviewer/ DRG Integrity Specialist Collaborate and communicate as necessary to clarify and avoid misinterpretation to ensure the query is optimally written and distributed to the correct client provider Creates queries in a compliant manner in accordance with AHIMA and ACDIS comp

The Utilization Review Specialist is responsible for the pre certification, concurrent, and discharge review process for clients at all levels of care, resulting in the approval of their admission and continued treatment. Job Duties and Responsibilities Consult with Admissions Department regarding specific LOC issues, insurance requests, and/or criteria questions. Complet

The Manager Clinical Audit provides oversight and leadership of the Clinical Audit Team within the Payment Integrity Department. The Clinical Audit team performs detailed medical record and chart audit review of the health plan's claims to ensure that all reimbursement to the provider is paid accurately. The Clinical Auditors are a liaison and resource between the health

Ensures CXM's data management activities are fully compliant with all regulatory requirements Other duties as assigned What We're Looking For Education Required BA/BS in a related field Education Desired BA/BS in a related field with strong emphasis in data analysis. Experience Required A minimum of 3 5 years of relevant work experience (i.e., data analytics informatics,

Ready to help us transform healthcare? Bring your true colors to blue. Position Summary This position does require travel within Massachusetts. This role will be responsible for representing Blue Cross Blue Shield MA's risk adjustment coding improvement initiatives through engagement with health care providers and non clinical team members. Collaborates with internal team

1. Quality 0= 1.1 Achieve and maintain a Department registration information completeness/accuracy of 95% as defined and measured on the individual work plan. 2. Support customer satisfaction initiatives as defined in the annual individual work plan. 2.1 External Customers (Patients, Families, Guests, Visitors) 3. Finance. 0= 3.1 Facilitate Time of Service (TOS) Collectio