Revenue Integrity Specialist Care New England Health SystemRevenue Integrity SpecialistWarwick, Rhode IslandFull timeAbout Us: Care New England Health System (CNE) and its member institutions, Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, is a trusted, integrated health care organization that fuels the latest advances in medical research, attracts the nation’s top specialty-trained doctors, hones renowned services and innovative programs, and engages in the important discussions people need to have about their health and end-of-life wishes. This role focuses on proactive review and resolution of missing or incorrect charges through daily monitoring of Epic Revenue Guardian reports and charge-related work queues, reconciliation of charges against clinical documentation, and collaboration with operational, clinical, and coding teams to ensure compliance with federal, state, and third-party payor guidelines.
NewPharmacy Benefit Verification Specialist Onco360Pharmacy Benefit Verification SpecialistWaltham, MassachusettsSkills/Knowledge: Required: Pharmacy insurance and benefit verification, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills. Pharmacy Benefit Verification Summary The Benefit Verification Specialist will investigate, review, and load accurate patient insurances, including medical and pharmacy coverage, assign coordination of benefits, run test claims to obtain a valid insurance response on patient medications, investigate/identify authorization requirements needed to obtain medication coverage, and enroll eligible patients in copay card assistance programs.
Senior Patient Financial Services Specialist Hebrew Rehabilitation CenterSenior Patient Financial Services SpecialistDedham, MassachusettsThis role requires specialized expertise in Massachusetts Medicaid (MassHealth), including application, renewal, and compliance processes, as well as a strong understanding of reimbursement models for custodial care, skilled nursing facilities (SNF), and managed care programs. The ideal candidate will serve as a key liaison between patients, families, clinical teams, admissions, MassHealth and payers to ensure timely coverage, guarantor education, and financial compliance.
Senior Patient Financial Services Specialist Per Diem Hebrew Senior LifeSenior Patient Financial Services Specialist Per DiemRoslindale, MA$54,022.04–$81,033.59 / yearThis role requires specialized expertise in Massachusetts Medicaid (MassHealth), including application, renewal, and compliance processes, as well as a strong understanding of reimbursement models for custodial care, skilled nursing facilities (SNF), and managed care programs. The ideal candidate will serve as a key liaison between patients, families, clinical teams, admissions, MassHealth and payers to ensure timely coverage, guarantor education, and financial compliance.
Senior Patient Financial Services Specialist Per Diem Hebrew Rehabilitation CenterSenior Patient Financial Services Specialist Per DiemDedham, MassachusettsThis role requires specialized expertise in Massachusetts Medicaid (MassHealth), including application, renewal, and compliance processes, as well as a strong understanding of reimbursement models for custodial care, skilled nursing facilities (SNF), and managed care programs. The ideal candidate will serve as a key liaison between patients, families, clinical teams, admissions, MassHealth and payers to ensure timely coverage, guarantor education, and financial compliance.
Senior Patient Financial Services Specialist Hebrew Senior LifeSenior Patient Financial Services SpecialistDedham, MA$54,022.04–$81,033.59 / yearThis role requires specialized expertise in Massachusetts Medicaid (MassHealth), including application, renewal, and compliance processes, as well as a strong understanding of reimbursement models for custodial care, skilled nursing facilities (SNF), and managed care programs. The ideal candidate will serve as a key liaison between patients, families, clinical teams, admissions, MassHealth and payers to ensure timely coverage, guarantor education, and financial compliance.
Pharmacy Claims Adjudication Specialist Onco360Pharmacy Claims Adjudication SpecialistWaltham, MassachusettsSkills/Knowledge Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills. ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any third-party rejections, obtain overrides if appropriate, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections Pharmacy Adjudication Specialists at Onco360.
Inpatient Coding Quality Specialist Brigham and Women's HospitalInpatient Coding Quality SpecialistSomerville, MA$30.60–$44.51 / hourEnsure coding practices align with official coding conventions, guidelines, and regulatory requirements set forth by organizations such as the American Medical Association (AMA), Centers for Medicare and Medicaid Services (CMS), and other relevant bodies. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success.
Inpatient Coding Quality Specialist, Remote Brigham and Women's HospitalInpatient Coding Quality Specialist, RemoteSomerville, MARemote$30.60–$44.51 / hourEnsure coding practices align with official coding conventions, guidelines, and regulatory requirements set forth by organizations such as the American Medical Association (AMA), Centers for Medicare and Medicaid Services (CMS), and other relevant bodies. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success.
Claims Review Specialist, Dsnp Brigham and Women's HospitalClaims Review Specialist, DsnpSomerville, MARemote$17.71–$25.28 / hourWorking with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success.
Coding Specialist Outpatient Telecommute-Surgical Coder Brown University HealthCoding Specialist Outpatient Telecommute-Surgical CoderRI$24.29–$40.07 / hourMonitors and resolves rejected accounts on the Claims Edit Report and e Clinical Works error reports by established timeframe researching coding conflicts including chargemaster, medical necessity and various other coding and billing issues. Reviews the outpatient clinical documentation of extract data and assign appropriate ICD-10-CM and CPT codes in accordance with the outpatient ICD-10-CM Official Guidelines for Coding and Reporting and the AHA HCPCS Coding Clinics.
Coding Specialist - Telecommute Brown University HealthCoding Specialist - TelecommuteProvidence, RI$24.29–$40.07 / hourMonitors and resolves rejected accounts on the Claims Edit Report and e Clinical Works error reports by established timeframe researching coding conflicts including chargemaster, medical necessity and various other coding and billing issues. Reviews the outpatient clinical documentation of extract data and assign appropriate ICD-10-CM and CPT codes in accordance with the outpatient ICD-10-CM Official Guidelines for Coding and Reporting and the AHA HCPCS Coding Clinics.
NewPatient Support Specialist Instructor Community College of Rhode IslandPatient Support Specialist InstructorProvidence, RIThe program prepares students for entry-level medical front-office and patient support positions in physician offices, outpatient practices, clinics, and other healthcare settings. The instructor will teach both theory and practical skills related to medical office operations, including medical terminology, patient communication, scheduling, electronic health records, medical insurance, patient registration, HIPAA, and customer service.
Accounts Receivable Specialist Pharmaron Beijing Co LtdAccounts Receivable SpecialistWaltham, MA$75,000–$80,000 / yearFounded in 2004, Pharmaron has invested in its people and facilities and established a broad spectrum of research, development, and manufacturing service capabilities throughout the entire drug discovery, preclinical, and clinical development process across multiple therapeutic modalities, including small molecules, biologics, and CGT products. We're looking for an Accounts Receivable Specialist to join our growing finance team and play a key role in managing customer accounts, driving collections, and ensuring timely payment of outstanding invoices.
Referral & Authorization Specialist Care New England Health SystemReferral & Authorization SpecialistWarwick, RICare New England Health System (CNE) and its member institutions, Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, is a trusted, integrated health care organization that fuels the latest advances in medical research, attracts the nation's top specialty-trained doctors, hones renowned services and innovative programs, and engages in the important discussions people need to have about their health and end-of-life wishes. This position is crucial to the organization s financial success and the delivery of a positive provider and patient experience, as their timely and accurate processing of referrals and authorizations ensures that patients receive the necessary care without delays, while also optimizing reimbursement.
Third Party Specialist Care New England Health SystemThird Party SpecialistWarwick, Rhode IslandFull timeAbout Us: Care New England Health System (CNE) and its member institutions, Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, is a trusted, integrated health care organization that fuels the latest advances in medical research, attracts the nation’s top specialty-trained doctors, hones renowned services and innovative programs, and engages in the important discussions people need to have about their health and end-of-life wishes. Demonstrates knowledge of accounts receivable payment policies and hospital contracts as they relate to billing, collection, follow-up, claim reimbursement, patient liability, and local, state and federal programs.
Patient Financial Clearance Specialist Care New England Health SystemPatient Financial Clearance SpecialistWarwick, Rhode IslandFull timeAbout Us: Care New England Health System (CNE) and its member institutions, Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, is a trusted, integrated health care organization that fuels the latest advances in medical research, attracts the nation’s top specialty-trained doctors, hones renowned services and innovative programs, and engages in the important discussions people need to have about their health and end-of-life wishes. This position is responsible for submitting Notices of Admissions (NOA) to payers, securing surgical authorizations, verifying surgical authorizations are on file, and providing patients with accurate cost estimates for services.
Referral Specialist Brown University HealthReferral SpecialistEast Providence, RI$19.03–$31.39 / hourThe core Success Factors include: Instill Trust and Value Differences Patient and Community Focus and Collaborate RESPONSIBILITIES: Schedule/coordinate/triage all referrals created by and sent to the practice via Lifechart work ques. Brown University Health employees are expected to successfully role model the organization''s values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another.
Referral Specialist Brown Health Medical GroupReferral SpecialistEast Providence, Rhode IslandThe core Success Factors include: Instill Trust and Value Differences Patient and Community Focus and Collaborate RESPONSIBILITIES: Schedule/coordinate/triage all referrals created by and sent to the practice via Lifechart work ques. Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another.
Payment Integrity Program Development Senior Manager - Clinical & Facility Specialist Devoted Health IncPayment Integrity Program Development Senior Manager - Clinical & Facility SpecialistWaltham, MARemote$110,500–$150,000 / yearData Hypothesis Validation: Perform primary data analysis (utilizing modern AI tools for SQL query generation) to test your clinical hypotheses across clinical settings, prove financial viability on real-world datasets, and design parameters that prevent provider abrasion. Cross-Functional Policy Leadership: Pitch your original clinical concepts to directors and executive stakeholders; drive consensus across Clinical Operations, SIU, Claims, and Legal to approve novel policy interpretations and rule architectures.