Site: Mass General Brigham Health Plan Holding Company, Inc.

 

At Mass General Brigham, we know it takes a surprising range of talented professionals to advance our mission—from doctors, nurses, business people and tech experts, to dedicated researchers and systems analysts. As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community.  We place great value on being a diverse, equitable and inclusive organization as we aim to reflect the diversity of the patients we serve.

At Mass General Brigham, we believe a diverse set of backgrounds and lived experiences makes us stronger by challenging our assumptions with new perspectives that can drive revolutionary discoveries in medical innovations in research and patient care. Therefore, we invite and welcome applicants from traditionally underrepresented groups in healthcare — people of color, people with disabilities, LGBTQ community, and/or gender expansive, first and second-generation immigrants, veterans, and people from different socioeconomic backgrounds – to apply.

 

This is a remote role that can be done from most US states.

 

Job Summary

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 ass distribute work assignments and train as needed.

Serves as a backup to the claim's supervisor for all essential functions.

 

Qualifications

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.

 

Additional Job Details (if applicable)

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 requiredExperience 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 - 35lbsCarrying Occasionally (3-33%) 20lbs - 35lbsPushing 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%)

 

Remote Type

Remote

 

Work Location

399 Revolution Drive

 

Scheduled Weekly Hours

40

 

Employee Type

Regular

 

Work Shift

Day (United States of America)

 

EEO Statement:

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.

 

Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.