Supervisor Claims Resolution Medicaid
Supervisor Claims Resolution Medicaid
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Salary Not Disclosed
1 Vacancy
Job Description
Mass General Brigham relies on a wide range of professionals including doctors nurses business people tech experts researchers and systems analysts to advance our mission. As a notforprofit we support patient care research teaching and community service striving to provide exceptional care. We believe that highperforming teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
Responsible for overseeing a team that assesses healthcare claims for accuracy compliance and eligibility ensuring that claims are processed efficiently and in accordance with industry standards regulatory requirements and organizational policies. This position will guide and support the claims review team handle escalations and collaborate with other departments to improve claims processing and ensure timely reimbursements.Qualifications
Essential Functions
- Supervise and manage a team of claims reviewers to ensure accurate and timely healthcare claims processing.
- Oversee claims review and analysis to ensure compliance with healthcare regulations payer requirements and organizational policies.
- Resolve escalated or complex claims issues ensuring appropriate adjudication and dispute resolution.
- Monitor team performance provide feedback and conduct regular evaluations to support professional growth.
- Implement and enforce policies and procedures to streamline the claims review process for greater accuracy and efficiency.
- Collaborate with billing coding and compliance teams to ensure adherence to regulatory and payer standards.
- Analyze claims data to identify trends address issues and recommend process improvements.
- Provide training guidance and ongoing education for new and existing team members on industry changes and standards.
Additional Job Details (if applicable)
Education
- Bachelors Degree Healthcare Administration required or Bachelors Degree Related Field of Study required
Can this role accept experience in lieu of a degree
Yes
Experience
- Experience in healthcare claims review or processing 35 years required
- Experience in a senior or leadership role 12 years required
Knowledge Skills and Abilities
- Strong knowledge of healthcare claims processes coding (CPT ICD10 and payer regulations.
- Excellent leadership communication and problemsolving skills.
- Proficiency in claims processing software and healthcare management systems.
- Strong attention to detail and the ability to manage multiple tasks and priorities.
Physical Requirements
- Standing Occasionally 333
- Walking Occasionally 333
- Sitting Constantly 67100
- Lifting Occasionally 333
- Carrying Occasionally 333
- Pushing Rarely (Less than 2
- Pulling Rarely (Less than 2
- Climbing Rarely (Less than 2
- Balancing Occasionally 333
- Stooping Occasionally 333
- Kneeling Rarely (Less than 2
- Crouching Rarely (Less than 2
- Crawling Rarely (Less than 2
- Reaching Occasionally 333
- Gross Manipulation (Handling) Constantly 67100
- Fine Manipulation (Fingering) Frequently 3466
- Feeling Constantly 67100
- Foot Use Rarely (Less than 2
- Vision Far Constantly 67100
- Vision Near Constantly 67100
- Talking Constantly 67100
- Hearing Constantly 67100
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
EEO Statement:
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 PeopleFocused half PerformanceFocused) 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.
Required Experience:
Manager
Employment Type
Full-Time
