Medicare Appeals Assistant

Site: Mass General Brigham Incorporated

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

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham we are at the forefront of transformation with one of the worlds leading integrated healthcare systems. Together we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.

Our work centers on creating an exceptional member experience a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds experiences and skills.

We are pleased to offer competitive salaries and a benefits package with flexible work options career growth opportunities and much more.

Responsible for supporting the Medicare appeals and claims resolution process ensuring timely submission and follow-up on appeals. Assists with gathering documentation tracking case statuses and coordinating communications between departments to ensure the accurate handling of claims. The ideal candidates can distinguish an inquiry coverage request appeal claims dispute and grievance to tirage which means being able to identify what an expedited request is. The ideal candidate has experience in QNXT and Epic.

Essential Functions
-Prepares and submits appeal documents and claims-related materials to insurance providers and other stakeholders.
-Maintains organized records of all appeals and claim-related communications and case statuses.
-Coordinates with billing and claims teams to ensure proper documentation for appeals.
-Assists with follow-up on pending appeals and communicates status updates to relevant parties.
-Supports the preparation of reports on appeals activity trends and outcomes.
-Handles correspondence related to appeals including letters forms and supporting documentation.
-Monitors appeal deadlines and ensure timely submission and follow-up.
-Provides administrative support to the billing/claims team and other departments as needed.

Education

• High School Diploma or Equivalent required

Experience

• At least 1-2 years of appeals and grievances experience required
• Medicare appeals/greivances is highly preferred
• At least 1-2 years of claims setting preferred

Knowledge Skills and Abilities

• Proficient organizational and time-management skills.
• Effective written and verbal communication abilities.
• Proficient in Microsoft Office and other billing software.
• Attention to detail and accuracy in document preparation.
• Ability to handle multiple tasks and work efficiently in a fast-paced environment.

Working Conditions

• This is a remote role with a Monday through Friday 8:30 AM to 5:00 PM schedule

Remote

399 Revolution Drive

40

Regular

Day (United States of America)

Pay Range

$19.81 - $28.30/Hourly

Grade

3

At Mass General Brigham we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive and any offer extended will take into account your skills relevant experience if applicable education certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however it does not encompass all elements contributing to your total compensation addition to competitive base pay we offer comprehensive benefits career advancement opportunities differentials premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

0100 Mass General Brigham Incorporated is an Equal Opportunity Employer. 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. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973 the Vietnam Veterans Readjustment Act of 1974 and Title I of the Americans with Disabilities Act of 1990 applicants who require accommodation in the job application process may contact Human Resources at .

Mass General Brigham Competency Framework