Supervisor Claims Resolution
Job Location:
Somerville, NJ - USA
Yearly Salary:
Posted:
Application Deadline:
Vacancies:
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
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 supervising the claims resolution team and managing its inventory of review requests and claims projects. The team reviews claims that have already been finalized when a provider requests further review through a form phone call or other channel or when a claims project identifies items requiring review. Ensures work is assigned prioritized and completed accurately and on time while providing staff guidance and maintaining compliance with applicable policies and requirements.
Essential Functions
-Supervises the daily operations of the claims resolution team including work assignments training coaching and performance management.
-Manages the inventory of provider review requests and claims projects monitoring volume aging and completion to ensure timely resolution.
-Prioritizes and distributes work based on deadlines complexity staff capacity and operational needs.
-Oversees the review of finalized claims submitted for reconsideration through provider forms phone calls and other channels.
-Identifies trends in review requests claim outcomes and inventory; escalates recurring issues and recommends corrective actions.
-Coordinates with payers and internal departments as needed to research claim issues and reach accurate resolutions.
-Develops and maintains procedures that support consistent reviews clear documentation and efficient inventory management.
-Ensures the teams work complies with applicable federal and state requirements and organizational policies.
-Prepares reports on inventory turnaround times staff productivity and resolution outcomes and identifies opportunities for improvement.
Qualifications
Education
- Associates degree required. Relevant experience may be considered in lieu of a degree.
Experience
- Three to five years of experience in healthcare claims management or billing required.
- One to two years of supervisory or leadership experience preferred.
Knowledge Skills and Abilities
- Strong knowledge of healthcare billing coding and claims regulations.
- Ability to analyze finalized claims identify trends in review requests and resolve claim issues accurately.
- Strong leadership skills including the ability to assign work coach staff and monitor team performance.
- Ability to manage a varied inventory of provider review requests and claims projects set priorities and meet deadlines.
- Clear communication skills for working with providers payers staff and internal departments.
- Strong attention to detail organization and problem-solving skills.
- Ability to collaborate across departments to improve claim review processes and resolution outcomes.
Additional Job Details (if applicable)
Working Conditions
- This is a full-time role with a Monday through Friday schedule generally 8:30-5:00 PM Eastern Time
- This position is eligible for remote work from approved U.S. locations subject to organizational requirements.
- Remote employees must maintain a stable internet connection and a secure private quiet workspace appropriate for handling confidential and protected health information.
- Remote workspace requirements including privacy and security standards may be verified in accordance with organizational policy
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$79560.00 - $115720.80/AnnualGrade
7EEO Statement:
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
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.
