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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.
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Job Summary
Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the worldās 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 ā 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 welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills.
We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more.
The Supervisor, Medicaid Claims Review is responsible for leading a high-performing team focused on Medicaid claims quality, payment accuracy, and adjudication integrity. This role oversees daily inventory management while driving continuous improvement through denial trend analysis, high-dollar claim oversight, and proactive identification of adjudication risks. The Supervisor partners cross-functionally with Configuration, Reimbursement Strategy, Pharmacy Operations, and Payment Integrity to strengthen claims outcomes and reduce rework across the enterprise.
Responsible for overseeing a team that assesses Medicaid 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
-Performs other duties as assigned
-Ensure that the medical claims include complete and accurate documentation supporting the services rendered, including physician notes, test results, and other relevant records.
-Analyze claim payment amounts and compare them to contracted rates, fee schedules, and industry benchmarks.
-Identify underpayments, overpayments, and potential billing errors.
-Conduct comprehensive audits of medical claims to verify compliance with billing regulations, payer policies, and internal policies and procedures.
-Stay updated on insurance company policies, billing guidelines, and reimbursement rules.
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Qualifications
Education
- Bachelor's degree required (experience can be considered in lieu of degree)
License
- Certified Professional Coder (CPC) preferred
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
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
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Additional Job Details (if applicable)
Working Conditions
- This is a full-time role with a Monday through Friday, 8:30-5:00 PM Eastern Time schedule
- This is a remote role that can be done from most US states
- Remote workdays require a stable, secure, quiet, and HIPAA-compliant workspace. This will be confirmed via Microsoft Teams video for all employees
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Remote Type
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Work Location
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Scheduled Weekly Hours
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Employee Type
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Work Shift
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Pay Range
$79,560.00 - $115,720.80/Annual
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Grade
7
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EEO Statement:
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Mass General Brigham Competency Framework
At Mass General Brigham, our competency framework defines what effective leadership ālooks likeā by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
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