Commonwealth Care Alliance
Healthcare Medical Claims Coding Sr. Analyst
PayCompetitive
LocationBoston/Massachusetts
Employment typeFull-Time
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Job Description
- Req#: 5001056711506
Employer Industry: Healthcare Services
Why Consider this Job Opportunity:
- Opportunity for career advancement and growth within the organization
- Competitive salary up to $90,000
- Remote work flexibility
- Supportive and collaborative work environment
- Chance to make a positive impact on healthcare reimbursement and coding
What to Expect (Job Responsibilities):
- Develop prospective claims auditing and clinical coding policies for Optum CES and Zelis edits
- Analyze and report outcome results on implemented edits
- Liaison between business partners and vendors, providing solutioning options and documentation
- Collaborate on system and data configuration into CES with BPaaS vendor
- Support collaboration on cost-saving initiatives specific to edits
What is Required (Qualifications):
- Bachelor's Degree or Equivalent experience
- 7+ years of Healthcare experience, specific to Medicare and Medicaid
- 7+ years progressive experience in medical claims adjudication and clinical coding reviews
- Extensive knowledge of Healthcare Revenue Integrity, Payment Integrity, and Analytics
- Knowledge and experience of claim operations, health care reimbursement, and public health care programs
How to Stand Out (Preferred Qualifications):
- Masters Degree
- Certified Professional Coder (CPC) or equivalent certification
- Experience with Optum Claims Editing System (CES) or similar editing tools
#HealthcareServices #HealthcareReimbursement #MedicalCoding #RemoteWorkOpportunity #CareerGrowth
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We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.About the company
Based in Massachusetts, Commonwealth Care Alliance (CCA) is a not-for-profit, community-based healthcare organization dedicated to improving care for individuals who are dually eligible for MassHealth (Medicaid) and Medicare with complex medical, behavioral health and social needs, including persons with disabilities. CCA offers two health plans: Senior Care Options (HMO SNP), for individuals ages 65 and over who have Medicare and MassHealth Standard or only MassHealth Standard; and One Care, a Massachusetts demonstration program for dual eligible individuals ages 21 to 64. These comprehensive health plans provide all the services covered under Medicare and MassHealth, and other benefits as determined necessary by an inter-professional care team in conjunction with CCA’s preferred provider network. For four consecutive years, CCA’s One Care plan received a top consumer rating for quality and access in the Consumer Assessment of Healthcare Providers and Systems (CAHPS) national survey of Medicare-Medicaid Plans (2016, 2017, 2018, and 2019), administered by the Centers for Medicare & Medicaid (CMS).