Responsible for researching and resolving disputes (contracts, corrected claims, filing limits, authorization and payer policy etc.) for providers, members and internal customers. Will coach and mentor claims resolution staff, as well as distribute work assignments and train as needed.
Serves as a backup to the claim's supervisor for all essential functions.
Essential Functions
- Supervise and support the claims processing team, providing guidance, training, and work assignments.
- Oversee the daily operations of the claims department, ensuring that claims are submitted accurately and within established timelines.
- Monitor the progress of claims submissions and follow-ups, addressing any delays or issues that arise.
- Collaborate with clinical staff, billing specialists, and external payers to resolve complex claims issues, denials, and appeals.
- Identify opportunities for process improvement and make recommendations.
- Review, research, and resolve the more difficult claims.
- Develop and implement standard operating procedures to enhance claims processing efficiency and accuracy.
- Analyze claims data to identify trends, areas for improvement, and opportunities to reduce denials and enhance collections.
Education
- Associate's Degree Healthcare Administration required or Associate's Degree Related Field of Study required
Can this role accept experience in lieu of a degree?
Yes
Experience
- Experience in claims processing or healthcare billing 2-3 years required
- Experience in a supervisory or lead role 1-2 years preferred
Knowledge, Skills and Abilities
- In-depth knowledge of medical billing, coding, and claims processing regulations.
- Strong leadership and team management skills to guide and motivate staff.
- Excellent analytical skills for evaluating claims data and identifying trends.
- Effective communication skills for collaborating with internal teams and external payers.
- Strong problem-solving abilities to address complex claims issues and denials.
- Proficiency in using electronic health record (EHR) systems and billing software.
Physical Requirements
- Standing Occasionally (3-33%)
- Walking Occasionally (3-33%)
- Sitting Constantly (67-100%)
- Lifting Occasionally (3-33%) 20lbs - 35lbs
- Carrying Occasionally (3-33%) 20lbs - 35lbs
- Pushing Rarely (Less than 2%)
- Pulling Rarely (Less than 2%)
- Climbing Rarely (Less than 2%)
- Balancing Occasionally (3-33%)
- Stooping Occasionally (3-33%)
- Kneeling Rarely (Less than 2%)
- Crouching Rarely (Less than 2%)
- Crawling Rarely (Less than 2%)
- Reaching Occasionally (3-33%)
- Gross Manipulation (Handling) Constantly (67-100%)
- Fine Manipulation (Fingering) Frequently (34-66%)
- Feeling Constantly (67-100%)
- Foot Use Rarely (Less than 2%)
- Vision - Far Constantly (67-100%)
- Vision - Near Constantly (67-100%)
- Talking Constantly (67-100%)
- Hearing Constantly (67-100%)
Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.
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Mass General Brigham Health Plan
Feb 19, 2025