The supervisor oversees daily operations of the DSNP utilization management staff, including direct coaching, supervision, and performance evaluation. They are responsible for ensuring accurate clinical reviews, monitoring staff productivity, and developing workflows to meet regulatory and organizational goals.
The Claims Review Specialist is responsible for reviewing and processing medical claims that require manual intervention to ensure accuracy and compliance with clinical guidelines. They must also collaborate with external departments to resolve claims errors and maintain performance goals regarding productivity and accuracy.
The PSC Registration Manager is responsible for supervising the patient registration team to ensure accurate data entry and efficient operational workflows. They also coordinate with billing and clinical departments to resolve registration issues and maintain high standards of patient service.
The Senior Revenue Analyst is responsible for analyzing, reporting, and optimizing revenue cycle data to support financial objectives. They collaborate with billing teams to address discrepancies, monitor KPIs, and implement process improvements to ensure billing accuracy.
The Data Scientist is responsible for analyzing complex clinical and operational data to uncover patterns and develop data-driven applications. They will design, implement, and evaluate predictive models and algorithms to solve business problems and optimize performance metrics.
The Appeals Coordinator manages the end-to-end lifecycle of member appeals and grievances for the Medicare line of business. This role involves investigating cases, documenting findings, and collaborating with internal and external stakeholders to ensure regulatory compliance.
The Utilization Management Nurse analyzes and assesses clinical information to render approval decisions for medical services. They also manage incoming authorization requests and ensure adherence to departmental performance metrics and clinical guidelines.
The specialist is responsible for analyzing, designing, and implementing process improvement initiatives to enhance operational efficiency and patient care quality. They will lead quality improvement projects, conduct root cause analysis, and collaborate with cross-functional teams to standardize workflows.
The Team Lead oversees daily operations of the prior authorization and referral department, ensuring timely and compliant processing of medical service requests. This role also provides leadership, mentorship, and training to staff while utilizing data tools to monitor performance and drive process improvements.
The specialist reviews and processes prior authorization and referral requests while ensuring medical necessity and insurance compliance. They collaborate with clinicians and patients to resolve authorization issues and maintain accurate documentation in the electronic health record.
The Financial Coordinator provides administrative assistance to the finance team by managing research study charge reviews, invoicing, and budget reconciliations. They also perform financial and productivity analyses to support departmental and organizational initiatives.
The Financial Coordinator provides administrative support to the Finance Management team by managing clinical trial budgets, charge reviews, and invoicing. They are responsible for conducting internal reconciliations and analyzing workflows to ensure billing accuracy and compliance.
The role involves investigating potential Coordination of Benefits (COB) recoveries through research, claims processing, and communication with internal and external stakeholders. The incumbent will manage COB inquiries, resolve Medicare Secondary Payer cases, and ensure accurate data maintenance in QNXT.
The Clinical Review Specialist assesses the medical necessity and appropriateness of healthcare services by reviewing medical records and treatment plans. They also participate in quality improvement initiatives and provide clinician-specific education regarding documentation standards and outcomes.
The Compensation Analyst II is responsible for managing and analyzing compensation programs to ensure competitiveness, pay equity, and regulatory compliance. This role involves conducting market research, designing salary structures, and providing expert guidance to HR and management.
The Director oversees Hospital and Professional Billing and Follow-Up activities, including monitoring accounts receivable, denial resolution, and payment trends. They are responsible for operationalizing strategic direction and improving staff, processes, and technology within Patient Financial Services.
The Agreement Associate II is responsible for negotiating, administering, and maintaining complex research contracts and subcontracts. They also serve as a primary resource for contract needs and assist in training junior staff members.
The Peer-to-Peer Utilization Review Nurse identifies, prepares, and clinically reviews cases requiring engagement with payers to address level-of-care denials. This role collaborates with physician advisors and interdisciplinary teams to ensure accurate determinations and compliant utilization practices.
The Utilization Management RN coordinates complex patient care needs, including service access, diagnostics, and treatment activities. They collaborate with the interdisciplinary team to develop individualized health care plans and facilitate effective discharge planning.
The specialist is responsible for monitoring and improving coding quality, documentation accuracy, and compliance with regulatory guidelines. They will also develop training programs and analyze medical records to ensure adherence to official coding conventions.
The Network Navigator proactively guides health plan members to in-network providers to improve access to care and reduce out-of-network utilization. This role coordinates between members, providers, and internal teams to schedule appointments and resolve access barriers.
The Trauma Data Analyst is responsible for developing and maintaining departmental databases and coordinating the submission of pertinent statistics and demographic data. They work closely with leadership and peers to ensure accurate documentation and smooth collaboration across the department.
Oversee accounting operations, including general ledger entries, reconciliations, and month-end close processes for assigned companies. Prepare, analyze, and report operating results while ensuring compliance with GAAP standards and internal policies.
The Adult Oncology Order Set Coordinator develops and manages Beacon protocols for oncology research and standard of care. They collaborate with multidisciplinary teams including pharmacy, nursing, and clinical trial departments to ensure accurate protocol implementation and maintenance.
The Coding Operations Coordinator oversees and coordinates coding operations, focusing on workflow management, operational efficiency, and process optimization. They ensure the timely progression of accounts through the coding lifecycle while collaborating with leadership and revenue cycle teams to implement performance initiatives.
The Communications Manager executes integrated communication plans for the Department of Orthopaedic Surgery and MGB Sports Medicine Service to enhance faculty and staff engagement. This role involves drafting persuasive content, maintaining editorial consistency, and collaborating with leadership to shape narratives that align with institutional priorities.
The Communications Manager executes integrated communication plans and drafts clear, persuasive content to support clinical departments and institutes. They collaborate with leadership and cross-functional teams to ensure editorial consistency and foster engagement across the organization.
The Senior Project Coordinator assists in the identification and documentation of project goals, metrics, and deliverables while supporting the development of project schedules. They also manage communication plans, triage client requests, and identify potential risks to ensure project success.
The specialist is responsible for designing and implementing coding education programs to ensure accuracy and compliance with medical coding guidelines. They will conduct training sessions, perform coding audits, and collaborate with clinical documentation teams to improve overall revenue cycle management.
The Finance Operations Lead will optimize data and analytic processes to support payer contracting, contract negotiation, and hospital reimbursement strategies. The role involves leading complex financial analyses, mentoring junior staff, and providing data-driven recommendations to executive leadership.
The Senior Medical Director provides strategic clinical leadership and medical oversight to ensure high-quality, cost-effective care for health plan members. This role involves guiding utilization management programs, leading quality improvement initiatives, and collaborating with cross-functional teams to support value-based care models.
Acts as a liaison between hospitals, insurance companies, and patients to verify coverage and obtain pre-authorizations for medical procedures. Educates patients on insurance benefits and manages the submission of accurate insurance claims.
The role manages the financial aspects of research grants, including budget development and proposal coordination. It ensures strict adherence to institutional and sponsor compliance while facilitating grant applications and financial reporting.
The Research Assistant will conduct interviews with healthcare providers in Ukraine and perform transcription, translation, and qualitative data coding. They will also serve as a cultural liaison and contribute to the preparation of research manuscripts and reports.
Deliver a structured virtual coaching intervention to educate and support caregivers of cancer patients. Assist caregivers in navigating the healthcare system and building psychosocial coping skills to improve patient outcomes.
The Program Manager serves as the operational hub for the Programs Team, coordinating logistics, managing project plans, and ensuring smooth communication. The role involves managing program data in Salesforce, improving operational workflows, and supporting training and event execution.
The IRB Vice Chair chairs convened IRB meetings and conducts expedited reviews to ensure compliance with federal, state, and local regulations. They lead the Other Events Committee and collaborate with Principal Investigators and leadership to protect human subject research.
Manage large-scale complex programs and projects related to Revenue Cycle Operations strategic initiatives. Lead cross-functional teams, manage budgets, and provide regular data-driven updates to leadership.
The Executive Director executes the physician compensation strategy and manages a team of professionals to oversee provider compensation programs. This includes managing financial, operational, and regulatory aspects while driving process improvements and operational excellence.
Ensure regulatory requirements for clinical trials are met by managing study binders and submitting protocol amendments to the IRB. Coordinate with clinical teams, sponsors, and federal agencies to document adverse events and maintain trial correspondence.
The role involves monitoring work queue volumes and supervising a billing and follow-up team to ensure timely claims submission and denial resolution. The supervisor is responsible for team coaching, performance evaluations, and identifying payer trends to improve operational efficiency.
The Technical Advisor oversees the integrity of ambulatory surgery coding and charging programs, providing guidance on audits and regulatory impacts. They collaborate with leadership and staff to implement coding systems, write policies, and provide education to ensure accuracy.
Acts as the primary liaison between hospital sites and the Revenue Cycle Operations team to optimize billing, coding, and financial performance. Responsibilities include analyzing performance data, managing issue lists, and executing improvement initiatives to enhance revenue capture.
Leads the editorial strategy and scientific review for departmental publications, press releases, and executive communications for the Chair of Ophthalmology. Manages the end-to-end nomination and application process for over 60 local, national, and international awards annually.
The APP works remotely to manage provider in-basket folders, including patient messages and urgent refills. They collaborate with MA and nursing staff to ensure patient care and coverage during provider absences.
