Claims Team Lead

4 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 key member of our claims resolution team, you will be responsible for researching and resolving disputes, coaching and mentoring claims resolution coordinators, and managing and distributing work as designated.

Key Responsibilities
  • Manage and distribute work as designated to ensure efficient claims processing and resolution.
  • Run and analyze reports to identify trends and areas for improvement in claims processing.
  • Review aging and inventory levels to ensure timely claims resolution and minimize delays.
  • Hold self and others accountable to meet commitments and deliver high-quality results.
  • Assist in testing new processes, system updates, and upgrades to ensure seamless integration and minimal disruption to claims processing.
  • Identify and provide claim scenarios for testing to ensure accurate and efficient claims processing.
  • Assist in the development, implementation, and delivery of training to ensure claims resolution coordinators have the necessary skills and knowledge to perform their duties effectively.
  • Function as a coach, mentor, and role model to staff, providing guidance and support to ensure their success and growth.
  • Establish and maintain effective customer relationships with internal stakeholders, serving as a liaison between departments to ensure seamless communication and collaboration.
  • Serve on the Desktop committee to create, update, and approve desktop procedures, ensuring compliance with regulatory requirements and company policies.
  • Act as a subject matter expert on desktop procedures, providing guidance and support to staff and other departments as needed.
  • Identify opportunities for process improvement and make recommendations to enhance claims processing efficiency and effectiveness.
  • Perform special projects as needed to support the claims resolution team and ensure timely and accurate claims processing.
Requirements
  • Bachelor's degree or equivalent combination of training and experience.
  • 3-5+ years of healthcare claims processing experience.
  • Strong leadership skills, with the ability to motivate and guide staff to achieve high-quality results.
  • Organized with the ability to prioritize and multi-task, ensuring timely and accurate claims processing.
  • Excellent verbal and written communication skills, with the ability to effectively communicate with internal stakeholders and staff.
  • Highly motivated, with a strong commitment to delivering high-quality results and exceeding expectations.
  • Ability to work independently, with minimal supervision, and as part of a team to achieve common goals.
  • Strong ability to hold information confidential, with a high level of integrity and professionalism.
  • Excellent collaboration skills, with the ability to work effectively with internal stakeholders and staff to achieve common goals.
  • Excellent customer service skills, with a strong commitment to delivering high-quality service and exceeding expectations.
  • 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, and be receptive to and seek out feedback, using self-discipline to adjust to feedback.
  • Accountable for delivering high-quality work, acting with a clear sense of ownership and commitment to excellence.
  • 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.

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