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6 results for Claims Processor Healthcare in Boston, MA

Medical Claims Analyst

North Providence, RI
onsite
Temporary / Contract
17.1 - 19.8 USD / Hourly
Position SummaryWe are seeking a detail-oriented Claims Analyst for a long-term contract on site in Providence, RI. Strong experience in Coordination of Benefits (COB), orthodontic or medical claims processing, and suspended/pended claims resolution. This role requires a thorough understanding of industry guidelines, plan provisions, and claim adjudication processes to ensure accurate and timely claim outcomes. Key ResponsibilitiesCoordination of Benefits (COB) Processing<ul><li>Review and adjudicate claims to determine primary and secondary coverage in accordance with COB rules</li><li>Verify subscriber and dependent eligibility across multiple insurance plans</li><li>Apply industry-standard guidelines to ensure accurate benefit determination</li><li>Calculate correct payment amounts following primary insurer adjudication</li><li>Adjust claims based on Explanations of Benefits (EOBs) received from other carriers</li></ul>Orthodontic Claims Processing<ul><li>Evaluate orthodontic treatment plans for coverage eligibility and plan compliance</li><li>Verify lifetime maximums, age limits, and plan-specific orthodontic provisions</li><li>Process initial banding/bonding claims and ongoing periodic payments</li><li>Calculate prorated payments over the course of treatment</li><li>Monitor continuation of treatment and confirm ongoing patient eligibility</li></ul>Suspended / Pended Claims Handling<ul><li>Analyze suspended or pended claims to identify errors, missing documentation, or review flags</li><li>Determine root causes such as eligibility discrepancies, coding issues, or COB conflicts</li><li>Prioritize suspended claims based on aging, urgency, and service-level agreements (SLAs)</li><li>Escalate complex or high-risk issues to senior analysts or supervisors as appropriate</li><li>Ensure timely and compliant resolution in accordance with turnaround time standards</li></ul>
2026-04-07T00:00:00Z

Claims Administrator/Specialist

Randolph, MA
onsite
Temporary to Hire
30 - 35 USD / Hourly
We are looking for a detail-oriented Claims Administrator to support a general contractor in the greater Boston area . This is a contract-to-permanent position, where you will play a pivotal role in supporting the Director of Risk Management with managing various insurance claims. You will collaborate with adjusters, attorneys, and other stakeholders to ensure claims are investigated thoroughly, processed efficiently, and resolved in a timely manner. Responsibilities:• Assist in managing and overseeing insurance claims, including general liability, workers' compensation, and auto liability.• Collaborate with adjusters, attorneys, and third-party carriers to investigate claims and determine liability.• Prepare comprehensive loss runs and claims reports to identify trends and areas of focus.• Compile and organize documentation required for Discovery requests and litigation processes.• Handle small nuisance claims that may not fall under existing insurance coverage.• Assess tender opportunities and make recommendations on settlements.• Provide support for claims related to construction, environmental liability, and property risks.• Ensure accurate processing of claims and maintain compliance with industry standards.• Utilize industry knowledge to interpret construction documents and evaluate construction litigation cases.• Work closely with stakeholders to address inquiries and provide updates on claim statuses.
2026-04-21T00:00:00Z

Medical Cash Applications Specialist

Shrewsbury, MA
onsite
Permanent / Full Time
55000 - 63000 USD / Yearly
We are looking for a detail-oriented Medical Cash Applications Specialist to support payment posting and account reconciliation activities in Shrewsbury, Massachusetts. This position plays an important role in maintaining accurate financial records, resolving payment variances, and partnering with billing teams to keep revenue cycle operations running smoothly. The ideal candidate brings healthcare accounts receivable experience, strong analytical skills, and a solid understanding of payer documentation and reimbursement practices. Responsibilities:• Record insurance, patient, and third-party payments, denials, and adjustments in the billing platform with a high level of accuracy.• Compare posted transactions against remittance documents, EOBs, ERAs, and related records to confirm that payment activity is complete and correct.• Review reimbursement differences, trace the source of posting issues, and take action to correct errors or escalate unresolved items when needed.• Enter contractual allowances and approved write-offs according to payer agreements and established reimbursement schedules.• Investigate unidentified receipts, rejected transactions, missing payments, and other cash application exceptions by coordinating with payers, internal teams, and leadership.• Support compliance by following healthcare billing standards, payer rules, and applicable regulatory requirements tied to payment posting activities.• Perform routine audits of cash application work to protect data integrity and ensure account balances reflect accurate financial activity.• Prepare summary reporting on posting accuracy, reconciliation results, and cash activity for management review.• Work closely with billing staff to address claim or account issues that affect payment application and overall accounts receivable performance.• Recommend workflow enhancements that improve efficiency, strengthen accuracy, and support timely completion of daily posting responsibilities. For immediate consideration please reach out ASAP Eric Lebow 508-205-2127
2026-04-20T00:00:00Z

Patient Access Specialist

Nashua, NH
onsite
Temporary to Hire
17.25 - 20.25 USD / Hourly
3rd Shift (Night Shift) Patient Access Specialist! 11:00pm-7:00am - Multiple Openings! We are offering a contract to permanent employment opportunity for a Patient Access Specialist in Nashua, New Hampshire. In this role, you will be fundamental in providing quality services to patients by managing their admission processes and ensuring regulatory compliance within the healthcare industry. Responsibilities: • Ensure precise assignment of MRNs and carry out medical necessity and compliance checks.• Efficiently handle incoming, outgoing, and inter-office calls via the telephone switchboard.• Adhere to organizational policies while delivering exceptional customer service with compassion.• Conduct pre-registration of patients' accounts prior to their visits, which may involve both inbound and outbound communication to gather demographic, insurance, and other patient information.• Inform patients, guarantors, or legal guardians about general consent for treatment forms, obtain necessary signatures, and distribute patient education documents.• Review responses in the insurance verification system, select the applicable insurance plan code, and enter benefit data to support Point of Service Collections and billing processes.• Use the Advance Beneficiary Notice (ABN) software to accurately screen medical necessity, inform Medicare patients of potential non-payment of tests, and distribute the ABN as needed.• Utilize auditing and reporting systems for quality assurance to correct accounts, including those from other employees, departments, and facilities.• Conduct account audits to ensure all forms are completed accurately and timely, meeting audit standards, and provide statistical data to Patient Access leadership.
2026-04-24T00:00:00Z

Medical Collections Specialist

Shrewsbury, MA
onsite
Permanent / Full Time
52000 - 61000 USD / Yearly
We are looking for a Medical Collections Specialist to support revenue cycle performance by managing insurance follow-up and resolving outstanding account issues. This position plays an important role in reducing aged receivables, addressing claim obstacles, and helping maintain accurate reimbursement activity. Based in Shrewsbury, Massachusetts, the role is well suited for someone who is detail-oriented, organized, and comfortable working across billing platforms and payer resources. Responsibilities:• Monitor unpaid insurance claims and take timely action to advance accounts toward resolution and payment.• Manage billing and follow-up activities for assigned payer accounts, ensuring all claims are worked accurately and consistently.• Investigate billing variances and payment discrepancies, then complete the necessary corrections to support proper reimbursement.• Identify rejected claims quickly, determine the cause, and complete corrective steps to prevent delays in claim submission or reprocessing.• Use clearinghouse tools to review claim activity and track submission issues, with familiarity in Waystar considered highly beneficial.• Navigate payer web portals to verify claim status, review remittance details, and complete required follow-up actions.• Participate in recurring accounts receivable review meetings and provide updates on account progress, trends, and barriers to payment.• Maintain clear and accurate documentation within billing or medical record systems to support account history and collection efforts. **Immediate needs here! Please reach out ASAP to me directly, Eric Lebow 508-205-2127**
2026-04-20T00:00:00Z

Medical Records Clerk PRN

Worcester, MA
onsite
Temporary / Contract
19.5 - 20 USD / Hourly
We are looking for a detail-oriented PRN Medical Records Clerk to join our team in Worcester, MA. In this long-term contract position, you will play a pivotal role in maintaining and managing patient records, ensuring accuracy, confidentiality, and compliance with healthcare regulations. This opportunity is ideal for professionals who excel in document management and are experienced with electronic medical record systems. Compensated: $20 per hour plus $.725 mileage. PRN role, seeking an individual that is looking for part time or permanent work. Must be able to travel up to 60 miles and have a valid driver's license. Responsibilities: • Accurately organize and maintain patient medical records, both physical and electronic, in compliance with healthcare regulations. • Ensure the confidentiality and security of medical records, adhering to HIPAA guidelines. • Retrieve, review, and update patient information using electronic medical record systems such as Allscripts and Cerner. • Collaborate with healthcare staff to provide timely access to accurate patient records. • Monitor and resolve discrepancies in medical documentation to ensure data integrity. • Assist in the transition and integration of medical records into electronic systems, as needed. • Respond promptly to requests for patient information from authorized personnel. • Conduct routine audits of records to maintain accuracy and compliance. • Stay updated on changes in medical record-keeping practices and technologies. • Provide support in training staff on the use of electronic medical record systems
2026-04-24T00:00:00Z