Top 74 Healthcare compliance Jobs in Massachusetts

Program Integrity Clinical Compliance Auditor
Optum —Boston, MA
- $29 - $52 an hour
- 8 hour shift
- Remote
- 18 years or older
- RN License
- Customer service
- On-the-job training
Coding Compliance Analyst
Optum —Worcester, MA
- $23.89 - $42.69 an hour
- 8 hour shift
- Remote
- Pass drug screening
- Mid-level
- High school diploma or GED
- AD&D insurance
- Employee stock purchase plan
Billing Compliance Reviewer
Dana-Farber Cancer Institute —Brookline, MA
- $93,800 - $106,000 a year
- Full-time
- 5 years
- Mid-level
- High school diploma or GED
Director of Compliance
Codman Square Health Center Inc —Boston, MA
- $114,000 - $177,000 a year
- Master's degree
- Human resources
- Ability to sit for extended periods
- Commuter assistance
- AD&D insurance
Quick Apply
13d
Coding and Compliance Auditor
South Shore Health —Weymouth, MA
- $73,000 - $104,400 a year
- Full-time
- Hybrid work
- 5 years
- Mid-level
- Acute care experience
Associate Executive Director - Corporate Compliance Officer
North Charles Mental Health Research and Training Foundation, Inc —Cambridge, MA
- $73,000 - $80,000 a year
- Full-time
- HIPAA
- Office
- Master's degree
- Health savings account
- Health insurance
Quick Apply
Director of Clinical Care and Compliance (RN license required)
Rogerson Communities —Boston, MA
- $135,000 - $150,000 a year
- Full-time
- Nursing
- 7 years
- RN License
Quick Apply
Sr Regulatory Affairs Specialist
Cardinal Health —Mansfield, MA
- $66,500 - $88,020 a year
- Remote
- Mid-level
- Bachelor's degree
- No degree
- Paid parental leave
- Health savings account
Compliance and Privacy Specialist
Beth Israel Lahey Health —Charlestown, MA
- $70,000 - $90,000 a year
- Full-time
- Microsoft Outlook
- Hospital
- HIPAA
5d
Manger, Transplant Quality & Regulatory Compliance
Beth Israel Lahey Health —Boston, MA
- $120,000 - $150,000 a year
- Full-time
- Hospital
- 5 years
- English
Billing Compliance Curriculum Development Specialist
Dana-Farber Cancer Institute —Boston, MA
- $83,400 - $91,100 a year
- Full-time
- Microsoft Excel
- 5 years
- Mid-level
Senior Billing Compliance Hospital Reviewer
Dana-Farber Cancer Institute —Boston, MA
- $116,700 - $132,000 a year
- Full-time
- Microsoft Office
- High school diploma or GED
- Bachelor's degree
Healthcare Compliance Operations Manager/ Senior Manager
Ionis Pharmaceuticals, Inc. —Boston, MA
- $72,800 - $129,967 a year
- Remote
- Analysis skills
- Bachelor's degree
- Travel
Quick Apply
3d
Pharmacy Network Auditor
RxSense —Boston, MA
- $74,000 - $110,000 a year
- Remote
- Microsoft Word
- 5 years
- Research
Quick Apply
5d
Analyst, Medicare Compliance
Blue Cross Blue Shield of Massachusetts —Hingham, MA
- $72,630 - $88,770 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Mid-level
- Health insurance
- Dental insurance
3d
Director Billing Compliance
Dana-Farber Cancer Institute —Brookline, MA
- $154,200 - $170,800 a year
- Full-time
- HIPAA
- Master's degree
- Bachelor's degree
Compliance Reporting Program Manager
Cohere Health —Boston, MA
- $110,000 - $125,000 a year
- Remote
- 8 years
- SQL
- Analysis skills
- Paid parental leave
- Health savings account
Quick Apply
Lead Director, Network Compliance & Regulator - Northeast
CVS Health —Boston, MA
- $100,000 - $231,540 a year
- Full-time
- Hybrid work
- Microsoft Excel
- Office
- 3 years
- Health insurance
- Dental insurance
12d
Director of Compliance & Regulatory Affairs (State of MA)
Regard Healthcare —Cummington, MA
- $100,000 - $140,000 a year
- Hybrid work
- Addiction Medicine
- Residential
- Master's degree
Quick Apply
12d
SIU Code Auditor
Fallon Health —Worcester, MA
- $87,500 a year
- Full-time
- Writing skills
- Mid-level
- 3 years
12d

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healthcare compliance jobs near massachusetts

Program Integrity Clinical Compliance Auditor

Optum -
Boston, MA

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Job Details

Full-time
$29 - $52 an hour

Benefits

On-the-job training

Qualifications

Spreadsheets
Administrative experience
Driver's License
Document review
Productivity software
Documentation review
Documentation reviews
Excel data analysis

Full Job Description

This position is Remote in Massachusetts. You will have the flexibility to work remotely* as you take on some tough challenges.

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.

The Program Integrity Clinical Compliance Auditor will be responsible for performing compliance reviews of medical and administrative documentation to identify instances of healthcare fraud and/or wasteful and abusive conduct by health care providers who submit claims for payment. This position will utilize information from claims data analysis, plan members, the medical community, law enforcement, employee conduct, and confidential investigations in order to document relevant findings. The Sr. Recovery Resolution Analyst will conduct site visits and desk audits of provider claims, and medical and administrative records, to gather and analyze all necessary information to determine whether subject adhered to state and federal compliance policies, reimbursement policies, and contract compliance. The Sr. Recovery Resolution Analyst will present and discuss audit findings with client and input information into Optum audit workflow tools and the client's case tracking system. Where applicable, the Auditor will support appeal and fraud investigation activities.

This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am - 5:00 pm local time. It may be necessary, given the business need, to work occasional overtime.

We offer weeks of on-the-job training. The hours of the training will be aligned with your schedule.

Primary Responsibilities:

Review medical and administrative records for audit/compliance review
Travel to provider sites up to 25%/month to collect records and engage with providers
Present and participate in discussions with the client regarding audit observations and findings
Collaborate with a team of 2-5 auditors to complete reviews
Enter audit findings data and notes in online/electronic platform using Excel-based templates
Attend and participate in dispute reviews and administrative hearings
Demonstrated written and verbal communications skills
Demonstrated customer service skills

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

High School Diploma / GED OR equivalent work experience
Must be 18 years of age OR older
Nurse licensure (RN or LPN) with a current, active, and unrestricted license in Massachusetts
Must have a Valid Driver's license
2+ years of experience reviewing health care documentation in a clinical or administrative role
Experience with MS Office Suite, specifically Word, PowerPoint, and Excel (including familiarity with basic formulas and data analysis)
Ability to travel up to 25% of the time within the state of Massachusetts as business needs dictate
Ability to work full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am - 5:00 pm local time. It may be necessary, given the business need, to work occasional overtime

Preferred Qualifications:

Clinical or administrative experience in long term care, for example, nursing facility care delivery/administration and/or community-based LTC service programs like Home Health
Experience in claim processing, healthcare provider information, and healthcare billing practices
Experience working in a remote/telecommute workspace
Working knowledge of medical terminology and claim coding with familiarity of CPT-4, HCPCs and ICD-10 code terminology
Familiarity with Medicaid program and/or billing requirements

Telecommuting Requirements:

Reside within Massachusetts.
Ability to keep all company sensitive documents secure (if applicable)
Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $29.00 to $52.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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Refine Your Search

healthcare compliance jobs in massachusetts

Program Integrity Clinical Compliance Auditor

Coding Compliance Analyst

Billing Compliance Reviewer

Director of Compliance

Coding and Compliance Auditor

Associate Executive Director - Corporate Compliance Officer

Director of Clinical Care and Compliance (RN license required)

Sr Regulatory Affairs Specialist

Compliance and Privacy Specialist

Manger, Transplant Quality & Regulatory Compliance

Billing Compliance Curriculum Development Specialist

Senior Billing Compliance Hospital Reviewer

Healthcare Compliance Operations Manager/ Senior Manager

Pharmacy Network Auditor

Analyst, Medicare Compliance

Director Billing Compliance

Compliance Reporting Program Manager

Lead Director, Network Compliance & Regulator - Northeast

Director of Compliance & Regulatory Affairs (State of MA)

SIU Code Auditor

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