Medicare Supervisor Claims Reviewer

Mass General Brigham • Somerville, MA

1d • $78,000 - $113,454 • Remote

About The Position

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.

Requirements

• Bachelor's Degree required (experience can be substituted in lieu of degree)
• 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
• 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.

Nice To Haves

• Medicare Advantage claims experience is highly preferred
• QNXT experience is highly preferred

Responsibilities

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees