Clinical Dynamix, Inc.Senior Manager/Associate Director, Clinical Data Management Clinical Dynamix, Inc.Senior Manager/Associate Director, Clinical Data ManagementWatertown, MAOversight of data collection tools (EDC, DTAs, EDC integrations) and essential documents (DMP, UAT Documents, data edit specifications, annotated case books and data entry guidelines). Contribute to the development of lessons learned and best practices as well as help develop SOPs and internal working procedures and process improvement initiatives.
Mass General BrighamInpatient Coding Quality Specialist Mass General BrighamInpatient Coding Quality SpecialistSomerville, MassachusettsEnsure 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.
athenahealth IncCoding Denial Management Associate athenahealth IncCoding Denial Management AssociateBoston, MA$50,000–$86,000 / yearWe offer IT solutions and expert services that eliminate the daily hurdles preventing healthcare providers from focusing entirely on their patients - powered by our vision to create a thriving ecosystem that delivers accessible, high-quality, and sustainable healthcare for all. Lead detailed claim adjudication analysis to triage rejections, denials, and payer edits; convert adjudication scenarios into consumable, effective processes that identify true root causes and lead to successful outcomes.
Vertex Pharmaceuticals IncDirector, AI Coding Platforms Vertex Pharmaceuticals IncDirector, AI Coding PlatformsBoston, MARemote$216,400–$324,600 / yearAny applicant requiring an accommodation in connection with the hiring process and/or to perform the essential functions of the position for which the applicant has applied should make a request to the recruiter or hiring manager, or contact Talent Acquisition at ApplicationAssistance@vrtx.com. Additionally, you will oversee a governed platform that enables scientists, researchers, and technical staff to securely integrate LLMs into their work while adhering to security and compliance frameworks.
Vertex PharmaceuticalsDirector, AI Coding Platforms - HYBRID Role Vertex PharmaceuticalsDirector, AI Coding Platforms - HYBRID RoleBoston, MassachusettsRemoteAny applicant requiring an accommodation in connection with the hiring process and/or to perform the essential functions of the position for which the applicant has applied should make a request to the recruiter or hiring manager, or contact Talent Acquisition at ApplicationAssistance@vrtx.com. Additionally, you will oversee a governed platform that enables scientists, researchers, and technical staff to securely integrate LLMs into their work while adhering to security and compliance frameworks.
Lahey Hospital and Medical CenterCoding Validator 3 (Remote) Lahey Hospital and Medical CenterCoding Validator 3 (Remote)Charlestown, MARemote$31.37–$50.20 / yearMinimum Qualifications:Education:\u2022 High School diploma or equivalent, required\u2022 Minimum of Associate degree in Health Information Management or Completion of a AHIMA or AAPC Coding Certification program, requiredLicensure, Certification & Registration: \u2022 RHIA, RHIT or CCS from AHIMA or a COC from AAPC, requiredExperience: \u2022 Computer skills\u2022 Minimum 5 year of ICD-10-CM, CPT/HCPC Outpatient coding assignment, required\u2022 Minimum 1 year of ICD-10-CM, CPT/HCPC outpatient coding assignment at a Level 1 trauma or Academic Medical Center, preferred\u2022 Minimum of 5 years OP coding auditing and/or OP coding validation, preferred \u2022 Microsoft Office applications\u2022 Interventional Radiology, Cardiac Cath, Injection and Infusion, Observation, and Ambulatory Surgery coding experience, requiredRequired Skills, Knowledge & Abilities: \u2022 Medical terminology \u2022Proficient in Microsoft Office Excel, Word and PowerPoint applications\u2022 Knowledge and understanding of current ICD-10-CM and CPT/HCPC Official Guidelines for Coding and Reporting\u2022 Knowledge of medical records content and management\u2022 Strong written communication skills\u2022 Working knowledge of the EMR either through experience or education, including experience working with structured data and database management\u2022 Knowledge of laws and regulations about health information and patient confidentiality\u2022 Adheres to Department, Hospital, and Human Resource Policies PreferredQualifications & Skills: \u2022 Epic experience\u2022 3M-360 Computer Assisted Coding Dept\u2022 OP Validator III level ICD-10-CM, CPT Outpatient code assignment skills based on BILH OP Coding Validator Exam Pay Range: $31.37 - $50.20The pay range listed for this position is the base hourly wage range the organization reasonably and in good faith expects to pay for this position at this time. The Coding Validator II is also responsible for exceeding quality and quantity expectations while performing coding functions to support timely coding and billingJob Description:Essential Duties & Responsibilities: \u2022 Performs pre-bill reimbursement audits on outpatient records to determine if codes need to be added/deleted, to ensure that the care of the patient is recorded in language that the payers can interpret, and coding is compliant with all coding guidelines.\u2022
Mass General BrighamCoding Education Specialist, Remote Mass General BrighamCoding Education Specialist, RemoteSomerville, MassachusettsRemoteThe 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. This role ensures that coding professionals have the knowledge and skills required to accurately assign medical codes, maintain compliance with coding guidelines, and contribute to the revenue cycle management process.
Brigham and Women's HospitalInpatient 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.
Brigham and Women's HospitalCoding Education Specialist, Remote Brigham and Women's HospitalCoding Education Specialist, RemoteSomerville, MARemote$63,648–$90,750.40 / yearThe 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. This role ensures that coding professionals have the knowledge and skills required to accurately assign medical codes, maintain compliance with coding guidelines, and contribute to the revenue cycle management process.
Code NinjasNewSTEM/Coding Instructor/Code Sensei Code NinjasSTEM/Coding Instructor/Code SenseiWaltham, MassachusettsWe’re looking for enthusiastic STEM/Coding Instructors (Code Senseis®) to create a fun, safe, and engaging learning environment where kids ages 5+ can explore coding, game development and STEM activities. Summer internship: 10-week commitment with flexible shifts: mornings, afternoons, or evenings Mon-Fri, plus Sat availability (10 AM–3 PM).
Code NinjasNewCoding Instructor for Kids Code NinjasCoding Instructor for KidsNorwood, MassachusettsIn our center, kids ages 7+ learn to code in a fun, non-intimidating way – by playing and building video games they love. Have the ability to learn our curriculum and teach Microsoft MakeCode, JavaScript, to different ages of students (Grade K-7).
athenahealth IncMedical Coding Automation Senior Associate athenahealth IncMedical Coding Automation Senior AssociateMA$77,000–$131,000 / yearThe Medical Coding Services team partners closely with Product, Operations, Commercial, Revenue Cycle, and R&D stakeholders to improve coding quality, reduce denials, optimize claim adjudication outcomes, and strengthen service integrity. In this role, the Medical Coding Automation Senior Associate will partner across Product, Operations, Commercial and R&D teams to identify workflow improvements, support automation initiatives, and drive operational excellence through data analysis and process optimization.
Lahey Hospital and Medical CenterBilling & Certified Coding Specialist I (Remote) Lahey Hospital and Medical CenterBilling & Certified Coding Specialist I (Remote)Charlestown, MARemote$25–$34 / hourReviews and corrects all claims/charge denials and edits that are communicated via Epic, Explanation of Benefits (EOB), direct correspondence from the insurance carrier or others and uses information learned to educate PFS and office staff to reduce future denials and edits of the same nature. Stays current on quarterly CCI Edits, bi-monthly Medicare Bulletins, Medicare''s yearly fee schedule, Medicare Website, and specialty newsletters.
Lahey Hospital and Medical CenterNewCoding & Compliance Manager, Surgery Lahey Hospital and Medical CenterCoding & Compliance Manager, SurgeryBoston, MA$92,955–$125,091 / yearMay perform additional job duties as time permits, such as: developing and presenting performance metric reports with a review of findings with Attending Physicians, Directors, Managers and Chiefs; service on committees; maintains relationship with third party billing companies to ensure continuous excellence in services; fosters relationships with affiliates related to coding and compliance. Monitors, proposes, and minimizes billing and coding operational inefficiencies by reviewing accuracy and production levels and communicating data analysis on audit trends, scrubber data, government audit requests, denials/appeals as well as developing and implementing corrective action plans for setting performance targets.
Mass General BrighamNewCoding Specialist, Pathology Mass General BrighamCoding Specialist, PathologySomerville, MassachusettsThe 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. Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission.
Mass General BrighamNewCoding Specialist II, Remote Mass General BrighamCoding Specialist II, RemoteSomerville, MassachusettsRemoteThe 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. Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission.
South Shore HealthCoding and Compliance Auditor South Shore HealthCoding and Compliance AuditorWeymouth, MAThe Coding & Compliance Auditor evaluates medical record documentation and coding accuracy, identifies opportunities for improvement, and designs and delivers coding education and training programs for clinical staff, coders and other key stakeholders. Support all departments of the Health System with coding guidance: Pertaining to compliance training / education as requested from providers and/or staff related to coding, billing and documentation in the inpatient, outpatient, professional, surgical and Home Health divisions of the Health System to ensure accuracy and support program objectives.
Brigham and Women's HospitalCoding Specialist II, Remote Brigham and Women's HospitalCoding Specialist II, RemoteSomerville, MARemote$22.22–$31.71 / hourThe 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. Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission.
Brigham and Women's HospitalInpatient Coding Specialist Brigham and Women's HospitalInpatient Coding SpecialistSomerville, MA$25.50–$36.49 / hourThe 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. Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission.
South Shore Health Systems IncCoding & Compliance Auditor South Shore Health Systems IncCoding & Compliance AuditorWeymouth, MA$73,000–$104,400 / yearResponsibilities if Required: Education if Required: License/Registration/Certification Requirements: Certified Coding Associate - American Health Information Management Association (AHIMA), Certified Coding Specialist - American Health Information Management Association (AHIMA), Certified Coding Specialist - Physician Based - American Health Information Management Association (AHIMA), Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC), Certified Professional Medical Auditor (CPMA) - American Academy of Professional Coders (AAPC), Registered Health Information Administrator - American Health Information Management Association (AHIMA). The Coding & Compliance Auditor evaluates medical record documentation and coding accuracy, identifies opportunities for improvement, and designs and delivers coding education and training programs for clinical staff, coders and other key stakeholders.
Lahey Hospital and Medical CenterProfessional Coding Manager Lahey Hospital and Medical CenterProfessional Coding ManagerCharlestown, MA$83,637–$112,570 / yearWorks with staff to ensure compliance of, and proper coding technique as defined by CMS regulations, Local Medicare Review Policies (LMRPs), Local Carrier Determinations (LCDs), the AMA, any applicable BILH compliance policies, and/or any relevant accrediting organizations. Attends management meetings, interacts with other managers to resolve problems, and conducts regular staff meetings to ensure consistent communication of the Coding department as well as BILH policies, expectations, and goals.
Brigham and Women's HospitalCoding Specialist II, Anesthesia Brigham and Women's HospitalCoding Specialist II, AnesthesiaSomerville, MA$22.22–$31.71 / hourThe 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. Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission.
Signature HealthcareAmbulatory Coding Lead Signature HealthcareAmbulatory Coding LeadWest Bridgewater, MAResponsible for insuring accurate diagnosis and procedure coding as well as providing documentation and coding related feedback and educational services to providers and coders. Monitors coding productivity and assigns/prioritizes daily work schedules for Coding Specialists, Risk Coders and charge entry staff.
Accenture PlcEpic Resolute Application Developer (Charge Router and Coding Skills) - 6260321 Accenture PlcEpic Resolute Application Developer (Charge Router and Coding Skills) - 6260321Boston, MAIn addition to delivering innovative solutions for Accenture's clients, you will work with a highly skilled, diverse network of people across Accenture businesses who are using the latest emerging technologies to address today's biggest business challenges. Dropping orders using chart review-> creating new patient encounter -> dropping an order and signing the order/Unite charge entry ->creating new encounter.
Home HelpersCoding Instructor Home HelpersCoding InstructorBelmont, MassachusettsWe recognize our direct care staff as our greatest asset and offer: competitive compensation, initial & ongoing training, flexible hours, and a FRIENDLY & SUPPORTIVE WORK ATMOSPHERE. As part of our school outreach program, we offer classes in all surrounding public school districts of Acton, Westford, Concord, Lexington, Arlington, Bedford, Burlington and Belmont areas.
Concorde EducationAfter-School STEM & Coding Instructor (Part-Time) Concorde EducationAfter-School STEM & Coding Instructor (Part-Time)Cambridge, MA$50–$100 / hourDepending on the assignment and student grade level, instructors may teach introductory block-based coding or beginner text-based programming. Classes typically meet once per week after school and focus on creativity, problem-solving, and building simple digital projects.
Concorde EducationCoding Instructor (Scratch) Part Time, After-School Program Concorde EducationCoding Instructor (Scratch) Part Time, After-School ProgramBoston, Massachusetts$50–$100 / hourConcorde Education partners with schools nationwide to deliver engaging, instructor-led enrichment programs in STEM, the arts, financial literacy, esports, and other high-interest subjects. Students will explore core programming concepts by building interactive Scratch projects such as games, animations, and digital stories.
Gather Health Primary Care IncRisk Adjustment Coding Specialist Gather Health Primary Care IncRisk Adjustment Coding SpecialistBoston, MA$65,000–$85,000 / yearGather's model achieves superior care by individualizing care and is reinforced by a three-prong approach: a unique care model quarterbacked by PCPs and supported by multi-disciplinary care teams, tailored Social Care Plans that are led by Gather Guides and facilitated by deeply rooted community partners, and a proprietary "Tech Enabled Home Model.". With deep expertise in the CMS-HCC Risk Adjustment Payment Model (V28), Hierarchical Condition Category (HCC) and CPT coding, the Specialist will serve as a trusted partner to providers, offering 1:1 feedback, leading group education sessions, and identifying opportunities for documentation improvement.
Creatio EMEA LTDAngular Technical Lead (No Code Area) Creatio EMEA LTDAngular Technical Lead (No Code Area)Boston, MAWho We're Looking For:We are looking for a Tech Lead to join the team responsible for Design Time tools for Freedom UI pages and platform capabilities that enable customers to customize and extend the Creatio system. In this role, you will lead the development of powerful UI tooling and customization features, shape technical decisions, mentor engineers, and ensure the team delivers scalable and high-quality solutions.
Creatio EMEA LTDNo-Code Business Analyst Creatio EMEA LTDNo-Code Business AnalystBoston, MAVersion Control: Utilize Git/SVN for version control, ensuring seamless collaboration, code integrity, and efficient management of application changesRequired Skills & Competencies:Proven experience in conducting business analysis and research tasks, including market research, competitor analysis, and gathering business requirements to shape product features. Web Services Integration: Create web services for system integration using no-code tools, including designing RESTful APIs and SOAP interfaces to enable seamless data exchange, ensuring adherence to security protocols, and providing documentation for developers and third-party systems.
Creatio EMEA LTDNo-Code Product Owner Creatio EMEA LTDNo-Code Product OwnerBoston, MADefine and defend product concepts, including grouping and detailing business requirements, developing go-to-market strategies, creating mockups, collaborating on UX/UI design together with UI designers, preparing presentation materials, drafting user stories, and coordinating with technical writers to document functionality across both internal and public-facing company resources. You will work on products that enable users to create, customize, and deploy applications using AI agents, coding agents, and modern automation technologies, helping shape the future of AI-native application development.
LanceSoft IncSoftware Engineer-Artificial Intelligence 5 Skill Code:6J7-Artificial Intelligence LanceSoft IncSoftware Engineer-Artificial Intelligence 5 Skill Code:6J7-Artificial IntelligenceCambridge, MAFull timeMust be able to work onsite in Cambridge, MA • No relocation offered Preferred Qualifications (Desired Skills/Experience): • Education or experience in AI Algorithms and/or use of AI Tools Typical Education/Experience: Technical Lead Engineer (Level 5) Education/experience typically acquired through advanced technical education from an accredited course of study in engineering, computer science, mathematics, physics or chemistry (e.g. Basic Qualifications (Required Skill/Experience): • Bachelor's degree and typically 3 or more years' experience in a software engineering classification or a Master's degree with 1 year of experience in a software engineering classification.
Ophthalmic Consultants of BostonSenior Medical Billing Specialist Ophthalmic Consultants of BostonSenior Medical Billing SpecialistPlymouth, MAFull timeAs a senior member of the team, you’ll play a critical role in optimizing revenue cycle performance by: Resolving complex claim edits, rejections, and denials with accuracy and efficiency. In this role, you will be a key contributor to the financial health of the organization, tackling complex billing challenges, supporting team development, and helping ensure a seamless experience for our patients and providers.
Evolve Chiropractic & WellnessExperienced Medical Billing Coordinator - Part Time Evolve Chiropractic & WellnessExperienced Medical Billing Coordinator - Part TimeBoston, MAWe are looking for someone with knowledge of PIP insurance billing, verifications, authorizations, obtaining referrals, and collecting money. Evolve is looking for an experienced Medical Billing Coordinator to join our dynamic team!
Dana-Farber Cancer Institute IncBilling Compliance Reviewer Dana-Farber Cancer Institute IncBilling Compliance ReviewerBROOKLINE, MARemote$84,000–$91,300 / yearPartner with clinical providers, coding/HIM, revenue integrity, pharmacy, nursing, research billing, and practice operations to remediate findings, implement internal controls, and monitor corrective actions; track effectiveness of remediation through defined metrics. Reporting to the Director of Billing Compliance, the Billing Compliance Reviewer plans and executes risk-based audits, analyzes documentation and coding for medical necessity and regulatory adherence, and recommends corrective actions to mitigate compliance risk.
Dana-Farber Cancer Institute IncDirector Billing Compliance Dana-Farber Cancer Institute IncDirector Billing ComplianceBROOKLINE, MARemote$154,200–$170,800 / yearResponsibilities include leading routine monitoring, assessing for and identifying areas of risk assessments, conducting investigations, responding to audits, providing consultation/guidance, and sharing program findings with providers and leadership. Reporting to the VP, Chief Compliance Officer with a dotted line reporting relationship to the VP, Revenue Performance Management, the Director of Billing Compliance is a strategic leader and subject matter expert responsible for ensuring the integrity, accuracy, and compliance of billing practices across the organization.
Deloitte Touche Tohmatsu LtdSenior Consultant, Health Insurance - Risk Regulatory & Compliance Deloitte Touche Tohmatsu LtdSenior Consultant, Health Insurance - Risk Regulatory & ComplianceBoston, MA$118,700–$218,600 / yearThe wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. Experience applying International Classification of Diseases, Tenth Revision (ICD-10), Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS) in claims, medical record, or appeals reviews.
Boston Medical CenterNewBilling Assistant-U Boston Medical CenterBilling Assistant-UBoston, MA$19.89–$24.26 / hourKnowledge health care billing and collection process including federal and state collection laws, legal collection practices and collection techniques at a level generally acquired through 2 to 3 years on-the-job training or experience in billing Medicare, Medicaid, Blue Cross, HMO, and Commercial insurance collection in a healthcare environment. Performs follow-up with insurance companies, workers compensation payers, other third party payers, medical groups, outside hospitals, and physician's offices to ensure timely payments of patient bills in accordance with the terms and conditions of each contract and/or insurance company policies.
Deloitte Touche Tohmatsu LtdHospital Billing Coordinator Deloitte Touche Tohmatsu LtdHospital Billing CoordinatorBoston, MA$50,000–$60,000 / yearOur purpose comes through in our work with clients that enables impact and value in their organizations, as well as through our own investments, commitments, and actions across areas that help drive positive outcomes for our communities. This compensation range is specific to the remote role and takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs.
CodaMetrixMedical Coder II/III CodaMetrixMedical Coder II/IIIBoston, MassachusettsThis role requires a proven ability to communicate highly complex coding issues and solutions to a wide range of stakeholders, alongside an unwavering commitment to continuous learning, quality, and innovation in medical coding practices. They will play a pivotal role in improving the quality and efficiency of coding operations by collaborating closely with cross-functional teams, including Machine Learning, Product, and Customer Implementations.
Boston Children's HospitalRevenue Integrity Program Manager Boston Children's HospitalRevenue Integrity Program ManagerWestwood, MA$99,153.60–$158,631.20 / yearIf appropriate to bill for new services, ensures related systems are set up correctly, tested, and monitors initial charging of services for proper billing as well as following. Certification preferred: Coding certification such as Certified Professional Coder (CPC), Certified Outpatient Coder (COC), or AHIMA Certified Coding Specialist (CCS).
Boston Children's HospitalProvider Revenue Integrity Specialist (hybrid) Boston Children's HospitalProvider Revenue Integrity Specialist (hybrid)Westwood, MA$69,888–$111,831.20 / yearCertification preferred: Coding certification such as Certified Professional Coder (CPC), Certified Outpatient Coder (COC), or AHIMA Certified Coding Specialist (CCS). Position Summary: Provider Revenue Integrity Specialist (hybrid) Key Responsibilities: Monitor departments' adherence to professional charge reconciliation, work-queue, and.
Boston Medical CenterPhysician Practice Coder Boston Medical CenterPhysician Practice CoderMA$24.04–$33.65 / hourSequences diagnoses, procedures and complications by following ICD-10-CM, CPT-4, and the Uniform Hospital Discharge Data Set (UHDDS); adheres to the Official Guidelines for Coding and Reporting, Coding Clinic guidelines and other regulatory guidelines as appropriate. This includes education, experience, skills, and certifications/licensures as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness.
Zelis Healthcare, Inc.Inpatient DRG Reviewer Zelis Healthcare, Inc.Inpatient DRG ReviewerBoston, MA$79,000–$99,750 / yearRN or LVN required • Inpatient Coding Certification required (CCS, CIC) within 4 - 6 months of hire date • 1 -3 years reviewing and or auditing ICD-10 CM, MS-DRG and APPR-DRG claims preferred • Experience and working knowledge of Health Insurance, Medicare guidelines and various healthcare programs • Experience performing readmission reviews, including evaluating relatedness, preventability, and compliance with readmission policies • Understanding of hospital coding and billing rules • Clinical skills to evaluate appropriate Medical Record Coding • Experience conducting root cause analysis and identifying solutions • Strong organization skills with attention to detail • Outstanding verbal and written communication skills. • Using the revised codes, regroup the claim using provided software to determine the 'new DRG' • Where the regrouped 'new DRG' differs from what was originally claimed by the provider, write a customer facing 'rationale' or 'findings' statement, highlighting the problems found and justifying the revised choices of new codes and DRG, based on the clinical evidence obtained during the review • Document all aspects of audits including uploading all provider communications, clinical rationale, and/or financial research • Identify new DRG coding concepts to expand the DRG product.
Dana-Farber Cancer Institute IncClinical Audit Response Specialist Dana-Farber Cancer Institute IncClinical Audit Response SpecialistBOSTON, MARemoteReporting to the Director of Patient Financial Services, the Revenue Protection Specialist is responsible for managing and responding to external audits from government and commercial insurance companies, as well as interpreting evolving payer policies to safeguard the Institutes revenue. The Revenue Protection Specialist will utilize their clinical expertise and knowledge of billing practices to address audit findings, interpret payer policies, prepare detailed responses, and implement corrective actions to enhance compliance and revenue integrity.
Lahey Hospital and Medical CenterDenial Specialist 1-Professional Billing Lahey Hospital and Medical CenterDenial Specialist 1-Professional BillingCharlestown, MA$22.05–$29.68 / hourActual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law. The PFS Denial Specialist I role is vital to ensure that hospital denied accounts are thoroughly reviewed for any opportunity to correct, refile and or appeal claims for re-processing and reimbursement.
Max AI, Inc.Regional Sales Manager - Dermatology Max AI, Inc.Regional Sales Manager - DermatologyBoston, MA$140,000–$220,000Market Feedback Loop: Working closely with the Product/Engineering team to relay customer feedback regarding payer-specific rules, integration blockers (e.g., ModMed/EMA API issues), and feature requests to shape the roadmap. Full-Cycle SaaS Ownership: Taking ownership of the entire sales lifecycle—from cold prospecting private practices and PE-backed groups to running technical demos, negotiating contracts, and closing.
Deloitte Touche Tohmatsu LtdSenior Consultant - Clinical Documentation Specialist Deloitte Touche Tohmatsu LtdSenior Consultant - Clinical Documentation SpecialistBoston, MA$110,700–$218,300 / yearOther skills include the ability to analyze, act and design action plans upon monthly and quarterly reports related to individual providers, facilities, MS-DRGs, APR, PSIs, severity of illness and risk of mortality, capture rates, quality metrics and can effectively prioritize their work activities. Clinical Payments Optimization: Assisting clients by validating that payments for clinical healthcare services comply with regulatory, clinical based evidence and contractual requirements while also determining that payments are appropriate for the type and level of care provided.
Mass General BrighamThird Party Reviewer Mass General BrighamThird Party ReviewerSomerville, MassachusettsThe 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. Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission.
Zelis Healthcare, Inc.Inpatient DRG Sr. Reviewer Zelis Healthcare, Inc.Inpatient DRG Sr. ReviewerBoston, MA$95,000–$120,650 / yearWhat You'll Bring to Zelis: Registered Nurse licensure preferred Inpatient Coding Certification required (i.e., CCS, CIC, RHIA, RHIT) 5+ years reviewing and/or auditing ICD-10 CM, MS-DRG, and APR-DRG claims preferred Solid understanding of audit techniques, identification of revenue opportunities, and financial negotiation with providers Experience and working knowledge of Health Insurance, Medicare guidelines, and various healthcare programs Strong understanding of hospital coding and billing rules Clinical and critical thinking skills to evaluate appropriate coding Strong organization skills with attention to detail Excellent communication skills both verbal and written, and skilled at developing and maintaining effective working relationships Demonstrated thought leadership and motivation skills, a self-starter with an ability to research and resolve issues. As part of the Price Optimization division, this role is responsible for conducting post-service, pre-payment and post pay comprehensive inpatient DRG Quality Assurance reviews in an effort to increase the savings achieved for Zelis clients.