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Senior Manager, IT Quality Assurance (Remote)

Commonwealth Care Alliance
Boston, MA
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Why This Role is Important to Us The Senior Manager, IT Quality Assurance is ...
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Summary
About the job:
part of the Business Solutions team responsible for QA testing, product management and solutions delivery. This role is the primary owner for the QA Managed Services program and will be critical in the definition and implementation of our Enterprise QA program to supports CCA's ability to serve our business and scale IT best practices. In this role, you will join a collaborative team that operates at a fast pace to solve problems and build a better future for our members and IT organization. Supervision Exercised: -...
Location:
Boston, MA
Job Type:
Full-Time
Permanent
Occupation:
Software Quality Assurance Analysts and Testers
Career Level / Education:
Associate's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
Certified Scrum Product Owner
Citrix Certified Administrator
Certified Software Manager
Workkeys
Applied Math
4
Graphic Literacy
5
Workplace Documents
5
apply
Detailed Job Information

Sr. Manager, Medicare Compliance - Remote

Commonwealth Care Alliance
Boston, MA
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Why This Role is Important to Us Under direction of the Director of Medicare ...
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Summary
About the job:
Compliance, the primary focus areas of this position include development and oversight of the regulatory coompliance program. This includes: Corrective Action Plan (CAP) management, regulatory reporting to Centers for Medicare Medicaid Services (CMS), State Agencies and Department of Insurance (DOI), oversight of the distribution and tracking of regulatory memos to the organization and marketing review. Supervision Exercised: Yes, which includes but is not limited to providing leadership, work direction, and...
Location:
Boston, MA
Job Type:
Full-Time
Permanent
Occupation:
Compliance Managers
Career Level / Education:
High school diploma or equivalent
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
N/A
Workkeys
Applied Math
4
Graphic Literacy
5
Workplace Documents
6
apply
Detailed Job Information

Director, Medicare Compliance - Remote

Commonwealth Care Alliance
Boston, MA
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Why This Role is Important to Us The Director of Regulatory Compliance works ...
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Summary
About the job:
directly with the Vice President Health Plan Regulatory Compliance/National Medicare Compliance Officer to develop and maintain an effective Health Plan Regulatory Compliance Program. This position is responsible for leading the development, implementation, and ongoing maintenance of elements of an effective Compliance Program, including Regulatory and Contractual Compliance for each CCA Program; GRC system implementation; Compliance Auditing and Monitoring programs. This position is also responsible for the...
Location:
Boston, MA
Job Type:
Full-Time
Permanent
Occupation:
Compliance Managers
Career Level / Education:
High school diploma or equivalent
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
N/A
Workkeys
Applied Math
4
Graphic Literacy
5
Workplace Documents
6
apply
Detailed Job Information

Sr. Analyst, Medicare Compliance - Remote

Commonwealth Care Alliance
Boston, MA
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Why This Role is Important to Us The primary focus areas of this position is ...
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Summary
About the job:
managing compliance issues and regulatory responses including Corrective Action Plan (CAP) monitoring, investigations, validation activities, and issue management. Support the organization with assistance in interpreting regulations and providing education. Supervision Exercised: No, this position does not have direct reports. What You'll Be Doing Management of Compliance Issues and Corrective Actions (CAPs) - Maintain documentation of all reported issues in the GRC tool - Conduct investigations as needed to confirm...
Location:
Boston, MA
Job Type:
Full-Time
Permanent
Occupation:
Regulatory Affairs Specialists
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
N/A
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
4
apply
Detailed Job Information

Director, Quality & Control Assurance (Remote)

Commonwealth Care Alliance
Boston, MA
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Why This Role is Important to Us Position Summary: The Director, Quality & ...
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Summary
About the job:
Control Assurance reports to the VP of Quality & Control Assurance is responsible for providing strategic leadership and oversight for the Quality & Control Assurance within CCA’s Compliance department. This position designs, continually matures, promotes, & develops a program that adheres to all applicable federal, state, and contractual requirements. This position and is responsible for designing quality and control assurance reviews of claims, Hierarchical Condition Categories (HCC) and clinical coding, call...
Location:
Boston, MA
Job Type:
Full-Time
Permanent
Occupation:
Accountants and Auditors
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
Certified Internal Auditor
Certified Information Systems Auditor
Certified Public Accountant
National Committee for Quality Assurance
Workkeys
Applied Math
4
Graphic Literacy
5
Workplace Documents
4
apply
Detailed Job Information

FWA Investigator Coder Sr. Associate (Remote)

Commonwealth Care Alliance
Boston, MA
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Why This Role is Important to Us Position Summary: The FWA Investigator ...
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Summary
About the job:
Coder Sr. Associate is an integral part of the Fraud, Waste & Abuse (FWA) Special Investigation Unit (SIU). The position reports directly to the Sr. Director, Fraud, Waste & Abuse. This position utilizes a variety of FWA investigative tools and techniques to complete activities required to identify compliance with state and federal results, regulations, and requirements. This position is responsible for completing a variety of program integrity reviews and activities within their required timeframes. This role requires...
Location:
Boston, MA
Job Type:
Full-Time
Permanent
Occupation:
Medical Records Specialists
Career Level / Education:
Postsecondary nondegree award
Salary:
Upper Middle Income Jobs ($50K-$79K)
Certifications / Licenses:
ICD-10 / ICD-9
Certified Coding Associate
Workkeys
Applied Math
3
Graphic Literacy
4
Workplace Documents
4
apply
Detailed Job Information

VP, Quality & Controls Assurance (Remote)

Commonwealth Care Alliance
Boston, MA
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Why This Role is Important to Us The Vice President, Quality & Controls ...
Details
Summary
About the job:
Assurance reports to compliance leadership, and strategically and operationally leads various quality reviews of claims, Hierarchical Condition Categories (HCC) and clinical coding, call monitoring, system technology upgrades, and other critical compliance/financial/operational controls and processes across the CCA enterprise, including all health plan and care delivery activities. These responsibilities include planning, executing, and evaluating results of quality audits/reviews and control/operational integrity...
Location:
Boston, MA
Job Type:
Full-Time
Permanent
Occupation:
Accountants and Auditors
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
Certified Internal Auditor
Certified Information Systems Auditor
Certified Public Accountant
National Committee for Quality Assurance
Workkeys
Applied Math
4
Graphic Literacy
5
Workplace Documents
4
apply
Detailed Job Information

Provider Directory Manager (Remote)

Commonwealth Care Alliance
Boston, MA
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Why This Role is Important to Us Reporting to the Manager, Credentialing & ...
Details
Summary
About the job:
Provider Data, the Provider Directory Manager will perform advanced technical provider directory services work within CCA. It will be the responsibility of the manager to conduct UAT and data analysis on a recurring basis to ensure data accuracy across all lines of business and markets. They will work closely with the PDM manager, sales and marketing as well as general users to make suggested improvements. Supervision Exercised: - No, this position does not have direct reports. What We're Looking For Required...
Location:
Boston, MA
Job Type:
Full-Time
Permanent
Occupation:
Information Technology Project Managers
Career Level / Education:
Bachelor's degree
Salary:
High Income Jobs ($80K-$99K)
Certifications / Licenses:
National Committee for Quality Assurance
Citrix Certified Administrator
Workkeys
Applied Math
5
Graphic Literacy
5
Workplace Documents
5
apply
Detailed Job Information

HIM Specialist (Part Time) (Remote)

Commonwealth Care Alliance
Boston, MA
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Why This Role is Important to Us Under the guidance of the Manager of Health ...
Details
Summary
About the job:
Information Management, the HIM Specialist I is responsible for following processes to ensure compliant release of records, request for records and accurate data entry into CCA’s Electronic Medical Record (EMR) Request and review EMR from partnering organizations to obtain pertinent member documentation (narrative notes, physical exam, lab values, vital signs, medications, diagnoses and clinical parameters, including health maintenance data). What We're Looking For Education (Required): - Associate degree or...
Location:
Boston, MA
Job Type:
Part-Time
Permanent
Occupation:
Medical Records Specialists
Career Level / Education:
Postsecondary nondegree award
Salary:
Upper Middle Income Jobs ($50K-$79K)
Certifications / Licenses:
Certified Coding Associate
Workkeys
Applied Math
3
Graphic Literacy
4
Workplace Documents
4
apply
Detailed Job Information

Supervisor, Health Information Management (Remote)

Commonwealth Care Alliance
Boston, MA
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Why This Role is Important to Us Position Summary: The Health Information ...
Details
Summary
About the job:
Management (HIM) Supervisor is responsible for the daily planning and monitoring of department operations, staffing and coordinating tasks to ensure timely completion to meet regulatory requirements at CCA. Supervision Exercised: Yes, which includes but is not limited to providing leadership, work direction, and performance feedback to subordinate staff. The HIM Supervisor shall supervise eight (8) Health Information Specialists Hires and trains staff. Conducts annual performance reviews and corrective action...
Location:
Boston, MA
Job Type:
Full-Time
Permanent
Occupation:
Medical Records Specialists
Career Level / Education:
Postsecondary nondegree award
Salary:
Upper Middle Income Jobs ($50K-$79K)
Certifications / Licenses:
Registered Health Information Technician
Registered Health Information Administrator
Certified Coding Associate
Workkeys
Applied Math
3
Graphic Literacy
4
Workplace Documents
4
apply
Detailed Job Information
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