Top 2023 Qualification validation specialist Jobs in Boston, Ma

Utilization Review Specialist
Charles River Recovery —Weston, MA
- $24 - $26 an hour
- Part-time
- Background check
- Nursing
- Addiction Medicine
Quick Apply
Corporate Governance Specialist
Federal Home Loan Bank of Boston —Boston, MA
- $80,500 - $132,250 a year
- Full-time
- Hybrid work
- Microsoft Outlook
- 5 years
- Office
Recertification Specialist
Beacon Communities LLC —Hyde Park, MA
- $27 - $32 an hour
- Full-time
- Microsoft Excel
- Sales
- Customer service
- Health savings account
- Paid holidays
Quick Apply
Learning Quality, Standards Training and Improvement Specialist/Senior Specialist (Contract - Evergreen)
Vertex Pharmaceuticals —Boston, MA
- $45 - $55 an hour
- Temporary
- Writing skills
- Mid-level
- 3 years
Guest Experience Expert
Marriott International, Inc —Boston, MA
- $31.42 - $33.20 an hour
- Full-time
- Hotel
- High school diploma or GED
- Front desk
Qualification & Validation Specialist
Eckert & Ziegler Radiopharma Inc —Wilmington, MA
- $90,000 - $120,000 a year
- Full-time
- Mid-level
- Communication skills
Quick Apply
Resource Specialist
Dana-Farber Cancer Institute —Boston, MA
- $56,600 - $61,500 a year
- Full-time
- Hybrid work
- Spanish
- Microsoft Outlook
- Writing skills
13d
Writing Specialist
Northeastern University —Boston, MA
- $33 an hour
- Full-time
- Mid-level
- 3 years
- Teaching
- Health insurance
- Dental insurance
Patient Relations Specialist, Patient Safety
Beth Israel Lahey Health —Boston, MA
- $79,996.80 - $119,995.20 a year
- Full-time
- Hybrid work
- Microsoft Excel
- Microsoft Outlook
- Hospital
13d
Provider Enrollment & Credentialing Specialist
Optum —Boston, MA
- $18 - $32 an hour
- Full-time
- Hybrid work
- Microsoft Excel
- Pass drug screening
- HIPAA
- AD&D insurance
- Employee stock purchase plan
Leave Specialist - REMOTE
Ryder System —Boston, MA
- $55,000 a year
- Full-time
- Remote
- Microsoft Excel
- Mid-level
- Analysis skills
- Disability insurance
- Health insurance
Disability Specialist
Northeastern University —Boston, MA
- $53,615.00 - $75,728.75 a year
- Full-time
- Experience working with individuals with disabilities
- Mid-level
- Master's degree
- Health insurance
- Dental insurance
Data Specialist
Contact Government Services, LLC —Boston, MA
- $61,152 - $82,992 a year
- Full-time
- Mid-level
- Training & development
- Health insurance
- Dental insurance
Quick Apply
Credentialing Specialist
One Federal Solution —Boston, MA
- Customer service
- Mid-level
- Administrative experience
Quick Apply
6d
Patient Service Specialist
Northeastern University —Boston, MA
- $23.37 - $32.14 an hour
- Full-time
- Computer literacy
- Windows
- Administrative experience
- Health insurance
- Dental insurance
Associate Training Specialist
Werfen —Bedford, MA
- $65,000 - $85,000 a year
- Online Application
- ERP systems
- Bachelor's degree
- Travel
- Health insurance
- Dental insurance
Demonstration Specialist
Deephealth —Somerville, MA
- $122,000 - $132,000 a year
- Full-time
- Remote
- OSHA
- Marketing
- HIPAA
Sr. Audit Specialist
Blue Cross Blue Shield of Massachusetts —Hingham, MA
- $89,460 - $109,340 a year
- Full-time
- Microsoft Excel
- Office
- High school diploma or GED
- Health insurance
- Dental insurance
Events Specialist
John Hancock Life Insurance Company (U.S.A.) —Boston, MA
- $61,875 - $103,125 a year
- Full-time
- Hybrid work
- Microsoft Word
- Microsoft Excel
- Microsoft Outlook
- AD&D insurance
- Paid holidays
9d
Specialist II Organizational Development
Ahold Delhaize USA —Quincy, MA
- $86,320 - $129,480 a year
- Full-time
- Hybrid work
- Mid-level
- Office
- Master's degree
13d

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qualification validation specialist jobs near boston, ma

Utilization Review Specialist

Charles River Recovery -
Weston, MA

Quick Apply

Job Details

Part-time
$24 - $26 an hour

Qualifications

Writing skills
High school diploma or GED
Productivity software
Clinical confidentiality policies
Medical terminology

Full Job Description

Position Overview: The primary purpose of the Utilization Review Specialist is to create and manage the flow of revenue for each client through liaison with insurance companies. The Utilization Review Specialist establishes a file on all incoming clients with insurance and maintains authorization for reimbursement from pre-certification through continuing stay reviews through discharge or referral. The Utilization Review Specialist uses communication, reading and writing skills to establish the best, most accurate position of need for each client to ensure maximum reimbursement for care and appropriate reimbursement for the level of care being provided. The Utilization Review Specialist has skills in gathering information from clinicians, navigating EMRs, and creating cases for presentation.

Specific Responsibilities:

Gather all information salient to insurance reimbursement.
Call insurance companies to obtain precertification or concurrent certification concurrent with the level of care

· · Establish positive relationships with insurance providers.

Identify trends in reimbursements and report out to supervisor through verbal report and generation of graphics.
Work closely with all departments
Keep accurate records of all transaction and communication with insurances.
Accurately transfer all information to the Billing Department
Provides corrective criticism and peer review.
Reported to work as assigned and keep workplace professional.
Maintain acceptable overall attendance.
Promote a favorable/positive work atmosphere.
Maintains safety of the physical environment.
Communicate effectively both orally and in writing.
Independently solve problems and follow through.
Organize and function independently in an office environment.
Other duties as assigned.

Minimum Qualifications

High School Graduate or equivalent. Post high school training in the medical field, the insurance field or in the behavioral health field preferred
A minimum of two years in the field of medicine, chemical dependency/substance abuse/psychiatric setting or human services field. Experience in third party reimbursements.
Licensure in nursing, social services helpful but not required.
Ability to work as a team member and have management, communication, organizational and interpersonal skills.
Ability to work under stressful conditions and be flexible in relation to department needs.
Understanding of medical and behavioral health terminology
Demonstrates Proficiency in Verbal and Written Communication Skills.
Knowledge of State and Federal Statutes Regarding Patient Confidentiality Laws.
Knowledge of Drug-Free Workplace Policies.
Knowledge of Corporate Integrity and Compliance Program.
Knowledge of current utilized technology.
Understanding of Insurance policy coverage limits.
Proficient in Microsoft Office
Satisfactory CORI and background check.
Satisfactory drug screen

Part Time Remote Role

Quick Apply

Refine Your Search

qualification validation specialist jobs in boston, ma

Utilization Review Specialist

Corporate Governance Specialist

Recertification Specialist

Learning Quality, Standards Training and Improvement Specialist/Senior Specialist (Contract - Evergreen)

Guest Experience Expert

Qualification & Validation Specialist

Resource Specialist

Writing Specialist

Patient Relations Specialist, Patient Safety

Provider Enrollment & Credentialing Specialist

Leave Specialist - REMOTE

Disability Specialist

Data Specialist

Credentialing Specialist

Patient Service Specialist

Associate Training Specialist

Demonstration Specialist

Sr. Audit Specialist

Events Specialist

Specialist II Organizational Development

I want to receive the latest job alert for qualification validation specialist in boston, ma

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