Medicare Supervisor Claims Reviewer
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Job Location:
Somerville, NJ - USA
Monthly Salary:
$ 78000 - 113453
Posted on:
4 hours ago
Vacancies:
1 Vacancy
Job Summary
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 not-for-profit we support patient care research teaching and community service striving to provide exceptional care. We believe that high-performing 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 of 4-5 employees that assesses Medicare 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.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.
Qualifications
Education
- Bachelors Degree required (experience can be substituted in lieu of degree)
Experience
- At least 3-5 years of experience in healthcare claims review or processing required
- At least 1-2 years of experience in a senior or leadership role required
- Medicare Advantage claims experience is highly preferred
- QNXT experience is highly preferred
Knowledge Skills and Abilities
- Strong knowledge of healthcare claims processes coding (CPT ICD-10) and payer regulations.
- Excellent leadership communication and problem-solving skills.
- Proficiency in claims processing software and healthcare management systems.
- Strong attention to detail and the ability to manage multiple tasks and priorities.
Additional Job Details (if applicable)
Working Conditions
This is a remote role that can be done from most US states
This role is 40 hours/week with five 8-hour days with a typical schedule of 8:30 am to 5:00 pm
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$78000.00 - $113453.60/AnnualGrade
7EEO 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 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.
Required Experience:
Manager
Key Skills
- Facilities Management
- Banking
- Content Writing
- Customer Support
- Fun
- Airlines
About Company
Patients at Mass General have access to a vast network of physicians, nearly all of whom are Harvard Medical School faculty and many of whom are leaders within their fields.
