by twochickswithasidehustle | Jun 16, 2026 | Uncategorized
remote typeRemotelocationsSomerville-MAtime typeFull timeposted onPosted 6 Days Agojob requisition idRQ4068484
Site: Mass General Brigham Incorporated
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. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job SummarySummary:
Responsible for ensuring proper coding compliance, documentation accuracy, and adherence to coding guidelines and regulations.
Does this position require Patient Care? No
Essential Functions:
-Assign appropriate diagnosis codes (ICD-10) and procedure codes (CPT/HCPCS) to patient encounters based on medical documentation, physician notes, and other relevant information.
-Ensure compliance with coding guidelines, including those outlined by the American Medical Association (AMA), Centers for Medicare and Medicaid Services (CMS), and other regulatory bodies.
-Analyze medical records, including physician notes, laboratory results, radiology reports, and operative reports, to extract pertinent information for coding purposes.
-Maintain a high level of accuracy and quality in coding assignments to ensure proper reimbursement and minimize claim denials.
-Utilize coding software, encoders, and electronic health record systems to facilitate the coding process.
-Support coding compliance efforts by participating in coding audits, internal or external coding reviews, and documentation improvement initiatives.
-Maintain accurate records of coding activities, including tracking productivity, coding accuracy rates, and any coding-related issues or challenges.
Qualifications
Education
High School Diploma or Equivalent required or Associate’s Degree Medical Billing and Coding preferred
Can this role accept experience in lieu of a degree?
No
Licenses and Credentials
Certified Professional Coder – American Academy of Professional Coders (AAPC) preferred
Experience
Medical Coding Experience 3-5 years required in Primary Care, Endocrine, Geriatrics, Urgent Care, Infectious Disease. Emphasis on strong skills for ICD 10 and EM leveling.
Knowledge, Skills and Abilities
– In-depth knowledge of medical coding systems, including ICD-10, CPT, and HCPCS, and their application in hospital billing.
– Familiar with coding guidelines and regulations, including those set by the AMA, CMS, and other relevant organizations.
– Strong analytical skills and attention to detail to accurately interpret medical documentation and assign appropriate codes.
– Excellent understanding of anatomy, physiology, medical terminology, and disease processes to support accurate coding.
– Excellent communication skills, both written and verbal, to interact effectively with healthcare providers and billing staff.
– Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment.
Additional Job Details (if applicable)
Remote Type
Remote
Work Location
399 Revolution Drive
Scheduled Weekly Hours
40
Employee Type
Regular
Work Shift
Day (United States of America)
Pay Range$22.22 – $31.71/Hourly
Grade4
At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.
by twochickswithasidehustle | Jun 16, 2026 | Uncategorized
You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose: Investigate allegations of potential healthcare fraud and abuse activity. Assist in planning, organizing, and executing claims investigations or audits that identify, evaluate and measure potential healthcare fraud and abuse.
- Conduct investigations of potential waste, abuse, and fraud
- Document activity on each case and refer issues to the appropriate party
- Perform data mining and analysis to detect aberrancies and outliers in claims
- Develop new queries and reports to detect potential waste, abuse, and fraud
- Provide case updates on progress of investigations and coordinate with Health Plans on recommendations and further actions and/or resolutions
- Assist with complex allegations of healthcare fraud
- Prepare summary and/or detailed reports on investigative findings for referral to Federal and State agencies
- Complete various special projects and audits
- Performs other duties as assigned
- Complies with all policies and standards
Education/Experience:
Bachelor’s Degree Business, Criminal Justice, Healthcare, or related field, or equivalent experience required. 1+ years Medical claim investigation, medical claim audit, medical claim analysis, or fraud investigation required. Strong Excel skills preferred. CFE (Certified Fraud Examiner) preferred.Pay Range: $56,200.00 – $101,000.00 per year
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual’s skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
by twochickswithasidehustle | Jun 16, 2026 | Uncategorized
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
– Rework team hours of operation are Monday through Friday from 6:00 AM – 7:30 PM Central Standard Time (CST)
– Schedule flexibility including nights, weekend, and holiday coverage.
– This is a full time work from home position
Position Summary
Quality Specialist- Medicare D Quality role administers the quality management system to manage the review of clinical processes, documentation, and patient records.
Interprets regulatory requirements from agencies and governing bodies to assist in the development of compliance policies and procedures.
Additional Responsibilities to include but not limited to the following:
– Learning the rework queues for each line of business
– Working rework reports timely
– Researching and troubleshooting failed claims
– Adding and/or editing overrides in RxClaim
– Logging audits and errors accurately and timely
– Ability to identify trends and provide suggestions for process improvement
– Researching and correcting any issues found in the overall process.
– Raising issues to Coverage Determination Clinical Pharmacists and Management team as needed.
– Reading, analyzing, and interpreting general business correspondence, technical procedures, and governmental regulations.
– Solving practical problems and dealing with multiple concrete variables in standardized situations.
– Performing basic mathematical calculations.
– Ensuring all cases are properly closed.
– Ability to interpret a variety of work instructions provided through multiple mediums.
– Ability to anticipate needs and resolve issues with urgency and to meet quality and production standards.
Required Qualifications
– 2 years of Coverage Determination & Appeals experience.
– MHK, RxClaim, and People Safe proficient.
– Meeting quality and productivity metrics in current role.
Preferred Qualifications
– 3 years of Coverage Determination & Appeals experience.
– 1 year of Medicare PART B experience
– MHK, RxClaim, and People Safe proficient.
– Meeting quality and productivity metrics in current role.
Education
High School Diploma or equivalent GED
Anticipated Weekly Hours40
Time TypeFull time
Pay Range
The typical pay range for this role is:$18.50 – $42.35
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 06/17/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
by twochickswithasidehustle | Jun 16, 2026 | Uncategorized
remote typeRemotelocationsWork From Home (HB)time typeFull timeposted onPosted Yesterdayjob requisition idR0051667
At Luminare Health , our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.
Join HCSC and be part of a purpose-driven company that will invest in your professional development.
Job Summary
This position includes a variety of claim administrative and technical tasks that support a Claim Unit and/or vendor staff, as well as the Claims Team and serves as a liaison for any internal departments.
In addition to these tasks, the Senior Claims Analyst is responsible for all of the same tasks as a Claim Analyst including the accurate adjudication and processing of medical, dental, vision, or other related claims, including related correspondence and/or electronic inquiries for assigned groups. All claims and inquiries are handled according to the established plan documents, claim processing guidelines, and established total turnaround times. Also advise team members regarding claim processing procedures.
Job Description
o Resolve client, employee/member, or provider issues regarding escalated or complex claims.
o Review and release over-authority claims up to limit specified by corporate policy.
o Handle claim referrals, including pre-determinations, using internal and external resources as needed. Advice Claim Analysts and/or vendor regarding claim processing.
o Handle network referrals as well as PPO repricing disputes.
o Review, analyze and interpret claim forms and related documents.
o Determine benefit coverage based on clinical edits, plan documents/booklets, benefit reference documents, Claim Reference Manuals and claims-related memoranda, and reports.
o Appropriately investigate, pend and refer claims based on claim procedures and guidelines.
o Accurately handle correspondence, claims, and referrals in the established timeframes and/or performance guarantees.
o Support the Claims reinsurance team, in the research and resolution of claims as assigned
o Handle complex or technical claim adjudication using internal and external resources as needed, e.g. transplants, experimental & investigational, chemotherapy, etc.
o Research and respond to vendor reconciliation requests.
o Mentor and assist with onboarding new Analysts, including the oversight of work
o Support the management, monitoring, and tracking of performance in collaboration with the Supervisor.
o Provide mentoring and coaching
o Assist Supervisor in documenting processes for analysts
o Other duties as needed/assigned
Required Job Qualifications:
o High School diploma or GED equivalent
o 3 years prior medical claim processing experience
o Ability to work in a fast-paced, customer centric & production driven environment
o Excellent verbal and written communication skills
o Ability to work effectively with employees/members, providers, clients and differing levels of co-workers including Client Managers and all levels of staff
o Demonstrated critical thinking, to carry out instructions furnished in oral, written or diagram form
o Flexible; open to continued process improvements
o Self-directed individual who works well with minimal supervision
o Good leadership, organizational and interpersonal skills
o Ability to effectively handle with complex situations and reach resolution
o Ability to analyze and interpret documents and Summary Plan Descriptions (SPDs)
o Ability to adapt to various system platforms, and to effectively use MS Excel/Word
Preferred Job Qualifications:
o Health Insurance/Third Party Administrator Experience
o High School diploma or GED equivalent
Required Job Qualifications:
- High School diploma or GED equivalent
- 3 years prior medical claim processing experience
- Ability to work in a fast-paced, customer centric & production driven environment
- Excellent verbal and written communication skills
- Ability to work effectively with employees/members, providers, clients and differing levels of co-workers including Client Managers and all levels of staff
- Demonstrated critical thinking, to carry out instructions furnished in oral, written or diagram form
- Flexible; open to continued process improvements
- Self-directed individual who works well with minimal supervision
- Good leadership, organizational and interpersonal skills
- Ability to effectively handle with complex situations and reach resolution
- Ability to analyze and interpret documents and Summary Plan Descriptions (SPDs)
- Ability to adapt to various system platforms, and to effectively use MS Excel/Word
Preferred Job Qualifications:
- Health Insurance/Third Party Administrator Experience
Location: This position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii.
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
EEO Statement:
We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
by twochickswithasidehustle | Jun 16, 2026 | Uncategorized
About Us:
Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals.
We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.
JOB SUMMARY:Medical Reimbursement Specialists work with insurance carriers and patients to resolve outstanding balances through research, follow ups and appeals.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.
- Edit and perform maintenance on Medicare claims.
- Follow-up on billed claims in a timely and effective manner.
- Maintain knowledge of current Medicare regulations and guidelines.
- Monitor patient accounts for accurate payment.
- Pursue account reimbursement through compliant action.
- Edit rejected claims in DDE which are identified on RTP report.
- Review patient bills for accuracy and completeness and obtaining any missing information.
- Utilization and adherence to Medicare guidelines.
- Other duties as assigned.
MINIMUM QUALIFICATIONS & REQUIREMENTS:
- High School Diploma or GED equivalent
- Two years (2) experience resolving medical Medicare claims
- Knowledge of Medicare and/or Medicaid payors
- Familiarity with CPT and ICD-10 coding preferred
- Knowledge of insurance billing and medical terminology preferred
- Familiarity with electronic and paper systems used in billing healthcare services
- Ability to research unpaid or underpaid claims for resolution
PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
by twochickswithasidehustle | Jun 16, 2026 | Uncategorized
Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We’re constantly reimagining what’s possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.
About the Opportunity
At Machinify, we’re constantly reimagining what’s possible in our industry—creating disruptively simple, powerfully clear ways to maximize our clients’ financial outcomes today and drive down healthcare costs tomorrow. As part of the Complex Payment Solutions Team, you will, as a Claims Administrator, be responsible for supporting efficient claims processing and ensuring data accuracy throughout the review and auditing process. This role involves performing incoming claim reviews, organizing data, assigning statuses, and routing completed files to auditors while maintaining document hygiene and adhering to internal procedures.
The position requires close collaboration with internal teams to manage import queues, reconcile balances, validate charges, identify, and address errors, and facilitate claims routing. The Claims Administrator I oversee the intake and output of files, responding to inquiries, resolving discrepancies, and ensuring effective communication regarding claims.
Additionally, this role includes analyzing data trends, monitoring file-sharing processes, verifying data transfer accuracy, and ensuring appropriate volume levels are maintained. Data entry of documents and other administrative tasks are also integral to the position.
The ideal candidate demonstrates strong organizational skills, attention to detail, and the ability to work collaboratively in a dynamic environment.
What you’ll do
- Review incoming claims, assign statuses, organize data, and route files to auditors.
- Collaborate with teams to manage the import queue, reconcile balances, validate charges, correct errors, and route files.
- Oversee file intake and output, addressing inquiries, discrepancies, and errors.
- Analyze data trends and communicate updates on claims routing, efficiency, inventory, and volume.
- Monitor file-sharing processes, ensure data transfer accuracy, and maintain appropriate volume levels.
- Perform data entry and support additional administrative tasks as needed.
What experience you bring (Role Requirements)
- Preferred experience in medical record review and knowledge of medical terminology.
- Proficient in Microsoft Office Suite, Adobe Acrobat, and multi-monitor setups; adaptable to company-specific software.
- Strong attention to detail, organizational, analytical, and critical thinking skills.
- Excellent interpersonal and teamwork abilities, capable of collaborating across functions and driving change.
What Success Looks Like…
After 3 months
- You will have a strong understanding of the role.
- You begin building relationships and collaborating with peers.
- You develop effective time and priorities management.
- You receive initial feedback about your performance and are using it to improve.
- You’ve gained confidence in your abilities and are starting to feel more comfortable in your role.
After 1 year
- You have mastered the tasks and responsibilities of the position, executing them with confidence and efficiency.
- You have established a strong network of internal relationships and are recognized as a key collaborator.
- You’ve been entrusted with greater responsibility indicating the company’s confidence in your abilities.
- You see opportunities for career progression and personal development.
Pay range: $24.00 USD per hour. This is a non-exempt position.
What’s in it for you
- PTO, Paid Holidays, and Volunteer Days
- Eligibility for health, vision and dental coverage, 401(k) plan participation with company match, and flexible spending accounts
- Tuition Reimbursement
- Eligibility for company-paid benefits including life insurance, short-term disability, and parental leave.
- Remote and hybrid work options
What values we’ll share with you
- Ask why
- Think big
- Be humble
- Optimize for customer impact
- Deliver results
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