Mass General Brigham Health Plan
Claims Team Lead
Mass General Brigham Health Plan, Somerville, Massachusetts, us, 02145
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.
Team Lead Responsibilities:
Manage and distribute work as designatedRun and analyze reportsReview aging and inventory levelsHold self and others accountable to meet commitmentsAssist in testing new processes, system updates and upgradesIdentify and provide claim scenarios for testing when neededAssist in the development, implementation, and delivery of trainingFunctions as coach, mentor and role model to staffEstablish and maintain effective customer relationships with internal stakeholders; Serve as liaison with other departmentsServe on Desktop committee for the creation, updating and approval of desktop proceduresAct as subject matter expert on desktop proceduresIdentify opportunities for process improvement and makes recommendationsPerform special projects as neededReview, 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 systemCommunicate and collaborate with other departments to resolve claims errors/issues, using clear, simple language to ensure understanding within the service level agreementLearn 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 neededKeep 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 serviceIdentify and escalate issues - systemic, configuration, pricing, etc., to attention of supervisor/manager in a timely manner
Qualifications
Required:Bachelor degree or the equivalent combination of training and experience3 - 5+ years of health care claims processing experienceStrong leadership skillsOrganized with the ability to prioritize and multi-taskExcellent verbal and written communication skillsHighly motivatedAbility to work independentlyStrong ability to hold information confidentialExcellent collaboration skillsExcellent customer service skillsDemonstrate 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 terminologyKnowledge of claim forms (professional and facility)Knowledge of Home Infusion Claim Processing preferredKnowledge of paper vs. electronic filing and medical billing guidelines preferredCompletion of coding classes from certified medical billing school preferredKnowledge of Microsoft Office required.Strong excel skills required
Mass General Brigham is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. 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.
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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.
Team Lead Responsibilities:
Manage and distribute work as designatedRun and analyze reportsReview aging and inventory levelsHold self and others accountable to meet commitmentsAssist in testing new processes, system updates and upgradesIdentify and provide claim scenarios for testing when neededAssist in the development, implementation, and delivery of trainingFunctions as coach, mentor and role model to staffEstablish and maintain effective customer relationships with internal stakeholders; Serve as liaison with other departmentsServe on Desktop committee for the creation, updating and approval of desktop proceduresAct as subject matter expert on desktop proceduresIdentify opportunities for process improvement and makes recommendationsPerform special projects as neededReview, 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 systemCommunicate and collaborate with other departments to resolve claims errors/issues, using clear, simple language to ensure understanding within the service level agreementLearn 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 neededKeep 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 serviceIdentify and escalate issues - systemic, configuration, pricing, etc., to attention of supervisor/manager in a timely manner
Qualifications
Required:Bachelor degree or the equivalent combination of training and experience3 - 5+ years of health care claims processing experienceStrong leadership skillsOrganized with the ability to prioritize and multi-taskExcellent verbal and written communication skillsHighly motivatedAbility to work independentlyStrong ability to hold information confidentialExcellent collaboration skillsExcellent customer service skillsDemonstrate 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 terminologyKnowledge of claim forms (professional and facility)Knowledge of Home Infusion Claim Processing preferredKnowledge of paper vs. electronic filing and medical billing guidelines preferredCompletion of coding classes from certified medical billing school preferredKnowledge of Microsoft Office required.Strong excel skills required
Mass General Brigham is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. 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.
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