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Claims Team Lead

1 month ago

Somerville, United States Brigham and Women’s Hospital Full time

Job Description - Claims Team Lead (3290186)

Job Number:

Claims Team Lead ( Job Number: 3290186 )

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world’s 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 consciously inclusive environment where diversity is celebrated.

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

The Claims Team Lead researches and resolves disputes (contracts, corrected claims, filing limits, authorization and payer policy etc.) for providers, members and internal customers; coaches and mentors claims resolution coordinators, manages and distributes work as designated, and assists with centralized and on the job training. The Claims Reviewer Team Lead serves as a backup to the claim's supervisor for all essential functions.

This is a hybrid role requiring an onsite presence to the Somerville office 1x/month.

  • Manage and distribute work as designated
  • Run and analyze reports
  • Review aging and inventory levels
  • Hold self and others accountable to meet commitments
  • Assist in testing new processes, system updates and upgrades
  • Identify and provide claim scenarios for testing when needed
  • Assist in the development, implementation, and delivery of training
  • Functions as coach, mentor and role model to staff
  • Establish and maintain effective customer relationships with internal stakeholders; Serve as liaison with other departments
  • Serve on Desktop committee for the creation, updating and approval of desktop procedures
  • Identify opportunities for process improvement and makes recommendations
  • Perform special projects as needed
  • Review, research and resolve the more difficult claims, call tracking and correspondence by navigating multiple systems and platforms and accurately capturing the data/information necessary for processing (e.g. verify pricing/Fee Schedules, contracts and Letters of Agreement, prior authorizations, applicable member benefits)
  • Create/update, work and close Call tracking records in record keeping system
  • Communicate and collaborate with other departments to resolve claims errors/issues, using clear, simple language to ensure understanding within the service level agreement
  • Learn and leverage new systems and training resources to help apply claims processes/procedures appropriately (e.g. on-line training classes, coaches/mentors)
  • Request clarification and or updates to policies and procedures as needed
  • Keep up to date with desktop procedures, payment policy guidelines, benefit updates, authorization rules and effectively apply this knowledge in the processing of claims and in providing customer service
  • Identify and escalate issues – systemic, configuration, pricing, etc., to attention of supervisor/manager in a timely manner

Required:

  • Bachelor degree or the equivalent combination of training and experience
  • 3 – 5+ years of health care claims processing experience
  • Strong leadership skills
  • Organized with the ability to prioritize and multi-task
  • Excellent verbal and written communication skills 
  • Highly motivated
  • Ability to work independently
  • Strong ability to hold information confidential
  • Demonstrate Mass General Brigham Health Plan Core Values of Accountability, Service Excellence, Quality Care, Diversity, and forging strong Relationships.
  • Respect the talent and unique contribution of every individual, culture and ethnic group and treat all people in a fair and equitable manner. 
  • Exercise self-awareness; monitor impact on others; is receptive to and seek out feedback; use self-discipline to adjust to feedback.
  • Accountable for delivering high quality work. Act with a clear sense of ownership.
  • Knowledge of ICD-10, HCPCS, CPT-4, and Revenue Codes.
  • Knowledge of medical terminology
  • Knowledge of claim forms (professional and facility)
  • Knowledge of Home Infusion Claim Processing preferred
  • Knowledge of paper vs. electronic filing and medical billing guidelines preferred
  • Completion of coding classes from certified medical billing school preferred
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