• Job Description

  Req#: 25-633
  Employer Industry: Healthcare Services
  
  Why consider this job opportunity:
  - Opportunity for career advancement and growth within the organization
  - Remote work opportunity for employees residing in Massachusetts
  - Engage in meaningful work that influences claims auditing and clinical coding practices
  - Competitive benefits package, including potential certification support
  - Collaborate with business partners and vendors to enhance coding and reimbursement processes
  
  What to Expect (Job Responsibilities):
  - Develop customized prospective claims auditing and clinical coding policies and configuration requirements
  - Conduct quarterly and annual reviews of new CPT and HCPCS codes related to Medicare/Medicaid policies
  - Analyze and report outcomes on implemented edits and provider billing patterns
  - Serve as a liaison between business partners and vendors, developing policies based on regulations
  - Collaborate on system and data configuration, performing user acceptance testing and analyzing post-production reports
  
  What is Required (Qualifications):
  - Bachelor’s Degree or equivalent experience
  - Minimum of 7+ years of healthcare experience, specifically in Medicare and Medicaid
  - 7+ years of progressive experience in medical claims adjudication, clinical coding reviews, or claims auditing
  - Extensive knowledge of Healthcare Revenue Integrity, Payment Integrity, and Analytics
  - 5+ years of experience with Facets Claims Processing System
  
  How to Stand Out (Preferred Qualifications):
  - Certification as a Certified Professional Coder (CPC), Certified Inpatient Coder (CIC), or Certified Professional Medical Auditor (CPMA) or willingness to obtain certification within one year
  - Master's Degree in a related field
  
  #HealthcareServices #MedicalCoding #ClaimsAuditing #RemoteWork #CareerAdvancement
  
  We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately.
  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).

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