Claims Team Lead

2 weeks ago

Somerville, Massachusetts, United States Mass General Brigham Health Plan Full time
Job Summary

Mass General Brigham Health Plan is seeking a highly skilled Claims Team Lead to join our team. As a Claims Team Lead, you will be responsible for researching and resolving disputes for providers, members, and internal customers, as well as coaching and mentoring claims resolution coordinators.

Key Responsibilities
  • 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
  • Function 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
  • Act as subject matter expert on desktop procedures
  • Identify opportunities for process improvement and make recommendations
  • Perform special projects as needed
  • Review, research, and resolve more difficult claims, call tracking, and correspondence
  • Create/update, work, and close Call tracking records in record keeping system
  • Communicate and collaborate with other departments to resolve claims errors/issues
  • Learn and leverage new systems and training resources to apply claims processes/procedures appropriately
  • 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 to attention of supervisor/manager in a timely manner
Qualifications
  • Bachelor degree or the equivalent combination of training and experience
  • 3-5+ years of healthcare 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
  • Excellent collaboration skills
  • Excellent customer service skills
  • 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
  • Knowledge of Microsoft Office required
  • Strong Excel skills required
Equal Opportunity Employer

Mass General Brigham Health Plan is an Equal Opportunity Employer. We are committed to creating a diverse and inclusive work environment where everyone feels valued and respected. We welcome applications from qualified candidates who share our values and are passionate about delivering exceptional service to our members.

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