53 jobs found in Boston

Job Description Summary 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. The Coding & Compliance Auditor monitors external regulatory and internal process changes and provides support to colleagues in adhering to Federal, State and local requirements. Job Description Job Responsibilities: Establishes, implements, and maintains a formalized review process for coding compliance, including a formal review (audit) process.    Responsible for conducting both routine and targeted audits to ensure clinical documentation supports accurate CPT, HCPC’s, PCS and ICD-10-CM codes.    Perform prospective and retrospective audits to validate medical necessity and documentation supportive of code selection. Analyzes data to identify deficiencies, prepare...

Job Description Summary 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. The Coding & Compliance Auditor monitors external regulatory and internal process changes and provides support to colleagues in adhering to Federal, State and local requirements. Job Description Job Responsibilities: Establishes, implements, and maintains a formalized review process for coding compliance, including a formal review (audit) process. Responsible for conducting both routine and targeted audits to ensure clinical documentation supports accurate CPT, HCPC’s, PCS and ICD-10-CM codes. Perform prospective and retrospective audits to validate medical necessity and documentation supportive of code selection. Analyzes data to identify deficiencies, prepare reports to deliver provider education...

Job Description Summary 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. The Coding & Compliance Auditor monitors external regulatory and internal process changes and provides support to colleagues in adhering to Federal, State and local requirements. Job Description Job Responsibilities: Establishes, implements, and maintains a formalized review process for coding compliance, including a formal review (audit) process. Responsible for conducting both routine and targeted audits to ensure clinical documentation supports accurate CPT, HCPC’s, PCS and ICD-10-CM codes. Perform prospective and retrospective audits to validate medical necessity and documentation supportive of code selection. Analyzes data to identify deficiencies, prepare reports to deliver provider education...

Job Description Summary 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. The Coding & Compliance Auditor monitors external regulatory and internal process changes and provides support to colleagues in adhering to Federal, State and local requirements. Job Description Job Responsibilities: Establishes, implements, and maintains a formalized review process for coding compliance, including a formal review (audit) process. Responsible for conducting both routine and targeted audits to ensure clinical documentation supports accurate CPT, HCPC’s, PCS and ICD-10-CM codes. Perform prospective and retrospective audits to validate medical necessity and documentation supportive of code selection. Analyzes data to identify deficiencies, prepare reports to deliver provider education...

Job Description Summary 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. The Coding & Compliance Auditor monitors external regulatory and internal process changes and provides support to colleagues in adhering to Federal, State and local requirements. Job Description Job Responsibilities: Establishes, implements, and maintains a formalized review process for coding compliance, including a formal review (audit) process.    Responsible for conducting both routine and targeted audits to ensure clinical documentation supports accurate CPT, HCPC’s, PCS and ICD-10-CM codes.    Perform prospective and retrospective audits to validate medical necessity and documentation supportive of code selection. Analyzes data to identify deficiencies, prepare...

**Job Family:**Strategy & Transformation Consulting**Travel Required:**Up to 25%**Clearance Required:**Nonecompanies. Guidehouse’s We continuously strive to foster an inclusive and diverse work culture and thoughtfully develop our people through challenging work, valuable learning and educational programs. We cultivate a culture of mentorship and feedback for professional and personal growth. We help our clients take control of their future. This mission extends to our employee's careers, health and well-being and by the many ways we give back to our communities. If you’re passionately motivated to make a difference and deliver exceptional work, we invite you to learn more about your career opportunities at**What You Will Do:*** Lead projects focused on medical affairs strategy, integrated evidence planning, real-world evidence study design and execution, and AI-enabled analytics approaches.* Develop solutions for evidence generation, real-world data utilization, and...

Job Family : Strategy & Transformation Consulting Travel Required : Up to 25% Clearance Required : None Is life sciences in your DNA? Breakthroughs in pharma are helping people live healthier lives, while medical devices enable patients to proactively maintain health - this is undoubtedly a transformative time for health care companies. Guidehouse's Life Sciences practice is an engine of innovation, helping pharmaceutical, biotech, medical device, and diagnostic companies develop custom solutions that tackle today's challenges, while anticipating tomorrow's. You will have an immediate impact by partnering with our clients, across all levels, to deliver product planning, pricing, reimbursement, product commercialization, and regulatory and compliance solutions. Do you think you are up for the challenge? We continuously strive to foster an inclusive and diverse work culture and thoughtfully develop our people through challenging work, valuable learning...

About Nucs AI Nucs AI is revolutionizing cancer care through cutting-edge AI and medical imaging technology. Founded in 2024 by a multidisciplinary team of oncologists, AI researchers, and healthcare innovators, we're tackling one of medicine's most pressing challenges: the growing demand for accurate, timely cancer diagnostics in the face of rising scan volumes and limited radiologist capacity. We sit at the intersection of diagnostics and treatment planning-building AI-powered tools at the convergence of medical imaging, radioligand therapy, and artificial intelligence. Starting with prostate cancer and expanding across oncology, we partner with world-leading medical institutions and pharmaceutical companies across the US, Europe, and Australia to bring precision oncology into everyday clinical practice. Our mission is to enhance diagnostic precision and expand access to expert-level cancer care, improving patient outcomes worldwide. We're venture-backed, early-stage,...

By clicking the “Apply” button, I understand that my employment application process with Takeda will commence and that the information I provide in my application will be processed in line with Takeda’s Privacy Notice and Terms of Use.  I further attest that all information I submit in my employment application is true to the best of my knowledge. Job Description About the role: The Associate Director, Medical Review, will serve as a functional expert in the area of Medical Review for their assigned region and products and ensure alignment and integration of process and technology efficiencies in medical review activities across diseases areas for Global Medical Affairs Oncology (GMAO). The individual in this role must excel in providing advanced medical and scientific review of commerical and medical affairs materials (promotional and non promotional materials) to support the non-promotional and promotional review processes. The Individual in this role will be...

About Us Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well. Our Core Values are: We serve faithfully by doing what's right with a joyful heart. We never settle by constantly striving for better. We are in it together by supporting one another and those we serve. We make an impact by taking initiative and delivering exceptional experience. Benefits Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include: Immediate eligibility for health and welfare benefits 401(k) savings plan with dollar-for-dollar match up to 5% Tuition Reimbursement PTO accrual beginning Day 1 Note:...

divvyDOSE is seeking a Senior Recovery Resolution Analyst for a remote position in Massachusetts. Your role will involve performing compliance reviews of medical and administrative documentation related to healthcare fraud or waste. Responsibilities include traveling to provider sites, collaborating with a team of auditors, and documenting findings. Must have an active nurse license in Massachusetts and at least 2 years of relevant experience. Competitive pay ranges from $28.94 to $51.63 per hour with benefits. #J-18808-Ljbffr

A nonprofit health insurance company is looking for a Coder to manage daily responsibilities of chart abstraction and audits in accordance with regulations. The role requires current coding credentials, strong organizational skills, and the ability to work independently in a remote environment. This position offers competitive compensation and excellent benefits, emphasizing both professional and personal employee wellbeing. Interested candidates should have a minimum of 5 years coding experience with a focus on Risk Adjustment coding. #J-18808-Ljbffr

It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances. Job Summary The Coder manages the day to day responsibilities of chart abstraction, vendor auditing and reporting in accordance with state and federal regulations. The coder will abstract from in-patient and out-patient medical records and record findings via electronic data base and or excel spread sheets. The coder ensures that all claims accurately reflect the appropriate diagnosis information as outlined in the member’s medial record. Our Investment In You Full-time remote work Competitive salaries Excellent benefits Responsibilities Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation. Ability to code government and state models. This includes code...

Job Type Full-time Description SCHEDULE: 40 hours, Monday-Friday, 8:00 a.m.-4:30 p.m. Pays $48,000 - $60,0000 annually DOE ( Salary ranges provided are based on relevant experience and skill set) LOCATION: 444 Harrison Avenue, Boston, MA This position is eligible for hybrid work in pursuant to Pine Street Inn's Remote Working Policy. There may be occasions when in-office work is required such as audits, licensing visits, or other organizational needs. The position is considered non-essential during weather or emergency events. SUMMARY OF POSITION: The HealthCare Authorization, Insurance Verification, and Medical Billing Specialist is responsible for supporting the full revenue cycle functions related to client eligibility, authorization acquisition, and medical billing. This includes securing insurance authorizations, verifying eligibility, performing detailed billing reviews, assisting with claims processing, documenting all activities, and coordinating...

Overview Xenon Pharmaceuticals (NASDAQ:XENE) is a neuroscience-focused biopharmaceutical company dedicated to drug discovery, clinical development, and commercialization of life-changing therapeutics for patients in need. We are looking for great people who thrive in a respectful, collaborative, inclusive, and productive culture to join the Xenon team. What We Do We are advancing an exciting product pipeline to address indications with high unmet medical need, including epilepsy, depression and pain. Our Phase 3 azetukalner program represents the most advanced, clinically validated potassium channel modulator in late-stage clinical development for multiple indications. In March 2026, we announced positive topline data from our Phase 3 X-TOLE2 study of azetukalner in focal onset seizures (FOS), and we anticipate submitting a New Drug Application to the Food and Drug Administration in the third quarter of 2026. Our Phase 3 epilepsy program also includes a second FOS study, X-TOLE3,...

Overview Location: Fully onsite at 200 Ballardvale St, Wilmington, MA 01887 (5 days/week) Pay Rate: $20/hour Schedule: 9a-5:30p (some flexibility available) Position Overview This role supports high-volume data quality and administrative efforts, focusing on reviewing, entering, and validating medical and financial documentation. The ideal candidate will have strong attention to detail, organizational skills, and the ability to work independently and collaboratively. Key Responsibilities Enter and maintain medical benefits data with high accuracy Create and update contact and account records Review and process high-volume data files Open, scan, and input mailed medical allocation reports Collaborate with team members on project work Perform general administrative and data-related tasks Project-Specific Responsibilities Review annuity and settlement documents Perform basic calculations to validate payment / annuity amounts. Able to identify if payment/annuity...

Overview When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. Under the general supervision of the Manager of Coding, the IP Coder III reviews inpatient records for accurate, timely, and compliant assignment of ICD-10-CM and ICD-10-PCS codes to ensure the correct MS-DRG, APR DRG, SOI assignments. The IP Coder III works closely with Coding leadership, IP Coding Validators, and collaborates with Clinical Documentation Staff to ensure coding uniformity, consistency, and accuracy with ICD-10-CM, ICD-10-PCS, Official Coding Guidelines, Federal and State regulations, the American Hospital Association coding guidelines and its publication Coding Clinic. The IP Coder III is responsible for meeting or exceeding quality and quantity expectations while performing coding functions to support timely coding and billing. This is a full-time, remote, inpatient, facility coding position. Essential Duties & Responsibilities Review...

A leading pharmaceutical company is seeking a Principal Medical Writer Associate Director. This remote position involves creating regulatory-compliant clinical documents, leading digital innovations, and managing project initiatives. Candidates should have over six years of experience in medical writing, strong regulatory expertise, and the ability to work within global teams. Competitive compensation and a comprehensive benefits package are offered. #J-18808-Ljbffr

By clicking the “Apply” button, I understand that my employment application process with Takeda will commence and that the information I provide in my application will be processed in line with Takeda’s Privacy Notice (https://jobs.takeda.com/privacynotice) and Terms of Use (https://www.takeda.com/terms-and-conditions/) . I further attest that all information I submit in my employment application is true to the best of my knowledge. Job Description Title: Associate Director, Clinical PV & Medical Quality, CPMQ Global Regions Location: US Remote About the role: As an Associate Director, Clinical PV & Medical Quality, CPMQ Global Regions, you will provide oversight from a clinical research and pharmacovigilance perspective of regulated post-authorization activities in the commercial business units and affiliates. You will drive a fit-for-use global Quality framework that elevates the capabilities in the business units and the affiliate and enables them to...

What We're Looking ForWe're looking for experienced and credentialed inpatient coders to become an integral part of our team. The ideal candidate for this role possesses high attention to detail and a depth of knowledge in medical terminology. This role is fully remote with a flexible schedule, allowing you to help shape the future of healthcare from your own workspace!What You Will DoAssign diagnostic and procedural codes using ICD-9-CM, ICD-10-CM, and ICD-10-PCS codesAccurately sequence and abstract medical codes from patient records, ensuring precision and adherence to documentationOversee and audit the work of Level 1 & 2 Coders, where applicableChampion documentation improvement opportunities and coding issues, facilitating resolution with relevant stakeholdersUphold an overall 95% coding accuracy rate and a 95% accuracy rate for MS-DRG assignmentsMaintain a minimum production of 1 chart per hour or site-specific productivity benchmarksFoster professional communication...