Medicare Supervisor Claims Reviewer

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Mass General Brigham Health Plan Holding Company, Inc.

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
** Responsible for overseeing a team of 4-5 employees that assesses Medicare claims for accuracy, compliance, and eligibility, ensuring that claims are processed efficiently and in accordance with industry standards, regulatory requirements, and organizational policies. This position will guide and support the claims review team, handle escalations, and collaborate with other departments to improve claims processing and ensure timely reimbursements.
Essential Functions  
-Supervise and manage a team of claims reviewers to ensure accurate and timely healthcare claims processing.
-Oversee claims review and analysis to ensure compliance with healthcare regulations, payer requirements, and organizational policies.  
-Resolve escalated or complex claims issues, ensuring appropriate adjudication and dispute resolution.
-Monitor team performance, provide feedback, and conduct regular evaluations to support professional growth.
-Implement and enforce policies and procedures to streamline the claims review process for greater accuracy and efficiency.
-Collaborate with billing, coding, and compliance teams to ensure adherence to regulatory and payer standards.
-Analyze claims data to identify trends, address issues, and recommend process improvements.
-Provide training, guidance, and ongoing education for new and existing team members on industry changes and standards.
** Qualifications
* *** Education
* ** Bachelor's Degree required (experience can be substituted in lieu of degree)
** Experience
* ** At least 3-5 years of experience in healthcare claims review or processing required
* At least 1-2 years of experience in a senior or leadership role required
* ** Medicare Advantage claims experience is highly preferred**
* ** QNXT experience is highly preferred
**** Knowledge, Skills, and Abilities
*** Strong knowledge of healthcare claims processes, coding (CPT, ICD-10), and payer regulations.
* Excellent leadership, communication, and problem-solving skills.
* Proficiency in claims processing software and healthcare management systems.
* Strong attention to detail and the ability to manage multiple tasks and priorities.
** Additional Job Details (if applicable)
**** Working Conditions
*** This is a remote role that can be done from most US states
* This role is 40 hours/week with five 8-hour days, with a typical schedule of 8:30 am to 5:00 pm
** Remote Type
** Remote
* * Work Location
** 399 Revolution Drive
** Scheduled Weekly Hours
** 40
* * Employee Type
** Regular
* * Work Shift
** Day (United States of America)
** Pay Range**$78,000.00 - $/Annual
** Grade
* * 7

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 package. In 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.
** EEO Statement:
** Mass General Brigham Health Plan Holding Company, Inc. 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…