Medicaid Claims Quality Lead
Mass General Brigham Health Plan
Mass General Brigham Health Plan is an employer within Mass General Brigham, dedicated to transforming health care with innovative solutions and a strong commitment to patient care and community service. The Supervisor, Medicaid Claims Review leads a high-performing team focused on Medicaid claims quality, payment accuracy, and adjudication integrity. This role oversees daily inventory management and works with cross-functional partners to drive continuous improvement. #J-18808-Ljbffr Mass General Brigham Health Plan
- Mass General Brigham Health Plan is seeking a Supervisor, Medicaid Claims Review to lead a high-performing team focused on Medicaid claims quality, payment accuracy, and adjudication integrity. The role oversees daily inventory, analyzes denial trends, and partners with...QualityClaimsRemote job
- ...transformation with one of the world's leading integrated healthcare systems. Together... ...opportunities, and much more. The Supervisor, Medicaid Claims Review is responsible for leading a... ...team focused on Medicaid claims quality, payment accuracy, and adjudication integrity...QualityClaimsWork at officeFlexible hours
- Mass General Brigham Health Plan Holding Company, Inc. seeks a Supervisor, Medicaid Claims Review to lead a high‑performing team focused on claims quality, payment accuracy, and adjudication integrity. This role oversees daily inventory and collaborates with cross‑functional...QualityClaimsRemote jobMonday to Friday
$122.25k - $176.58k
...internet websites and social media (global). Define the minimal quality standard and processes to be applied worldwide. Support the set... ...transformation initiatives like Gen AI, Modular Content, Core Claims, and or other MLR programs.Familiarity with regulatory technology...QualityClaimsFull timeWork at officeLocal areaWorldwide$206.25k - $297.92k
...JobAs the Real-World Evidence (RWE) Strategy Lead, you will establish and execute RWE... ...scientific rigor that demonstrates commitment to quality.Work seamlessly with partners and... ...Experience working with routinely collected data (claims databases, electronic medical health...QualityClaimsFull timeLocal area$125k - $150k
Financial Recovery Technologies (FRT) is a leading technology-based services firm that helps... ...community identify eligibility, file claims, and recover funds from securities class... ...acquisition and nurture programs that drive high-quality pipeline.Own campaign performance end-to-...QualityClaimsTemporary workWork at office2 days per week3 days per week$79.56k - $115.72k
...transformation with one of the world's leading integrated healthcare systems. Together... ...opportunities, and much more. The Supervisor, Medicaid Claims Review is responsible for leading a... ...team focused on Medicaid claims quality, payment accuracy, and adjudication integrity...QualityClaimsFull timeWork at officeRemote workMonday to FridayFlexible hoursShift work$90k - $95k
...Every Cure is supported through funding from leading philanthropic organizations like Chan... ...Source Commitment: Many of our methods' code, quality-checking tools, and knowledge graph... ...measurement experience. Experience working with claims, EHR, registry, or other real‑world...QualityClaimsWork at officeLocal areaFlexible hoursShift workDay shift3 days per week- ...global professional services company with leading capabilities in digital, cloud and... ...functional specifications. Participate in quality management reviews of the design and performance... ...support. Epic Tapestry certification in Claims, E&E, Benefits Engine, CRM, or UM -...QualityClaimsFull timeWork experience placementLive inWork at officeLocal area
$121.87k - $164.88k
...Position Summary The Lead Data Architect will lead the design, build, and evolution... ...at Coverys (notably underwriting, claims, actuarial, finance, and enterprise analytics... ...Define standards for data modeling, data quality, naming conventions, metadata, lineage,...QualityClaims$83k - $120.5k
...Nourishing at Home Program and Research Lead oversees the strategic development, implementation... ...is responsible for program operations, quality improvement activities, research and... ...health record data, survey tools, claims data, and program metrics to track outcomes...QualityClaimsFull timeTemporary workFixed term contractTraineeshipFlexible hours$192.4k - $302.39k
...Oncology Business UnitJob DescriptionAs Lead Counsel, Brand Attorney, you will be responsible... ...-kickback and bribery statutes, false claims acts, transparency laws and other... ...the Food, Drug & Cosmetic Act (FDCA), the Medicaid Statute (Title XIX of the Social Security...ClaimsMinimum wageLocal areaRemote work$233k - $420k
...governance, consumer data privacy, digital claims transformation, cybersecurity resilience,... ...regulations, we are choosing to lead. To fulf ill o ur vision, we ar e reshaping... ...unified operating model - driving volume, quality, cycle time, and cost outcomes from a...QualityClaimsFull timeWork at officeLocal areaHome officeShift work- ...Role Lead Counsel, Brand Attorney in Takeda's Oncology Business Unit, providing legal... ...(FDA regulations, anti-kickback, false claims, transparency, HIPAA, privacy) review brand... ...Anti-kickback Statute, FCA, FDCA, Medicaid, IRA, ACA strong analytical, communication...Claims
- ...Association (AMA), Centers for Medicare and Medicaid Services (CMS), and other regulatory bodies.... ...purposes. Maintain a high level of accuracy and quality in coding assignments to ensure proper reimbursement and minimize claim denials. Utilize coding software, encoders...QualityClaimsRemote work
$202.13k - $336.88k
...Life at GSK | GSK Discovery Disease Area Lead, Cardiovascular-Renal Diseases At GSK, we are dedicated to improving the quality of human life by leveraging scientific advancements... ...please visit the Centers for Medicare and Medicaid Services (CMS) website at #J-18808-Ljbffr...QualityWork at officeLocal areaRemote workRelocation2 days per week3 days per week$130k - $150k
...health care and digital health. You will lead client engagements, manage and galvanize... ...tracking, staffing and billability.Ensure the quality of the account team(s) is held to the... ...make payments to any unverified sources claiming to be connected to Real Chemistry. We are...QualityClaimsWork experience placementWork at officeLocal areaRemote workFlexible hours2 days per week- Gallagher Bassett is seeking a senior supervisor to lead a Workers' Compensation claims team in a fully remote capacity. The role focuses on delivering high-quality service, mentoring adjusters, and aligning practices with company standards. Requirements include a long...QualityClaimsRemote job
- ...Management Supervisor in Burlington, MA. This role provides leadership to the Nurse Case Management team within the Claim Department and ensures high-quality care coordination and return-to-work planning. The position requires a BSN or bachelor’s degree, Certified Case...QualityClaims
- ...Document rate negotiation accurately for proper claims adjudication. Identify and refer... ...NH, or compact license. Medicare and Medicaid knowledge. Strong oral and written communication... ...-solving abilities with a focus on quality improvement initiatives. Regular and...QualityClaimsWork at officeRemote workNight shiftAfternoon shift
- ...with departmental policy and within each Medicaid, ACA, CMS or NCQA mandated turnaround times... ...rate negotiation accurately for proper claims adjudication Identify and refer potential... ...problem-solving abilities with focus on quality improvement initiatives Working Conditions...QualityClaimsWork at officeRemote work
- ...Utilization Management, Case and Care Management, Quality, and Clinical Operations teams as... ..., and expirations. Coordinate with Claims and Provider Relations to resolve authorization... ...a TRICARE, USFHP, Medicare Advantage, Medicaid, or other HMO/capitated managed care...QualityClaimsWork at officeLocal area
- Accenture helps the world’s leading enterprises reinvent by building their digital core and... ...every value stream from quoting through claims — will capture significant five-year transformation... ...scope and delivery risk, and owning the quality of workstream outputs at client sites and...QualityClaimsFull timeLive inWork at officeLocal areaShift work
- ...We are seeking an experienced Computer System Validation (CSV) Lead to oversee validation activities for computerized systems used in... ...decommissioning projects. Coordinate validation activities with IT, Quality Assurance, Engineering, Manufacturing, and Business teams....Quality
- Mass General Brigham Health Plan Holding Company, Inc. is seeking a Claims Resolution Supervisor to lead our claims review team with remote-capable options. Based in Massachusetts, this full-time role oversees daily operations, assigns work, coaches staff, and ensures...ClaimsRemote jobFull time
$178.5k - $257.83k
...impossible into possible for millions. As Global Periodic Reporting Lead within our Pharmacovigilance team, you will ensure and develop... ...a wide range of health and wellbeing benefits including high-quality healthcare, prevention and wellness programs and at least 14 weeks...QualityFull timeWorldwide$177k - $278.08k
...Drug Discovery by proactively scouting emerging capabilities, leading technical diligence, and partnering closely with stakeholders across... ...Looks LikeIn this role, success will include:Building a high-quality pipeline of external opportunities aligned to Takeda’s...QualityMinimum wageWork at officeLocal area2 days per week3 days per week$192.4k - $302.39k
...inspire you and empower you to shine? Join us as a Global Medical Lead, PDT Hematology (f/m/x) in our Cambridge, MA office.At Takeda,... ...Strategically support the GPT, Research & Development, Clinical Science, Quality, Safety, Regulatory, Manufacturing, and Legal throughout -...QualityMinimum wageTemporary workWork experience placementWork at officeLocal areaRemote work$206.25k - $297.92k
Job title: Global Lead, Scientific Platforms & Engagement StrategyLocation: Cambridge, MA, Morristown, NJAbout the JobAt Sanofi, we chase... ...a wide range of health and wellbeing benefits including high-quality healthcare, prevention and wellness programs and at least 14...QualityFull time$139k - $186k
About This RoleThe lead of digital marketing measurement and data science is responsible for driving US business performance across digital... ...PowerPoint deliverable; close attention to detail, with a quality-focused mindset; aptitude for, and enjoyment of, working in teamsRobust...QualityFull timeTemporary workLocal area
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