Supervisor, Commercial Claims Reviewer - Somerville, MA

Site: 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 ca ...

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 ...

Site: Mass General Brigham IncorporatedMass 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, teachin ...

Site: Mass General Brigham Incorporated · 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, teac ...

Responsible for overseeing a team that assesses healthcare 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 guid ...

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. · Review claims to ensure accurate coding, appropriate documentation, and compliance with applicable billing regulations and payer guidelines. · ...

We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities. · ...

The Claims Operations Manager is responsible for managing commercial claims operations to ensure efficient and accurate processing of claims. Oversees claims workflows, compliance, and team performance to support revenue cycle goals and optimize reimbursement processes. · ...

The Payment Policy Manager is vital to the team responsible for developing implementing and managing payment policies strategies by analyzing regulatory changes reimbursement models optimize revenue ensure compliance federal state payer specific guidelines. · This role complement ...

Site: Mass General Brigham IncorporatedMass 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, teachin ...

The Insurance Support Nurse participates in the timely management of denials that are received in the Care Coordination Department.Through sound knowledge of utilization management, the nurse is able to assess a patient's level of care after review of the medical record. · ...

The Insurance Support Nurse participates in the timely management of denials that are received in the Care Coordination Department. Through sound knowledge of utilization management, the nurse is able to assess a patient's level of care after review of the medical record. · For n ...

The Insurance Support Nurse participates in the timely management of denials that are received in the Care Coordination Department. Through sound knowledge of utilization management, the nurse is able to assess a patient's level of care after review of the medical record. · For n ...

Job Summary · The Insurance Support Nurse participates in the timely management of denials that are received in the Care Coordination Department.Through sound knowledge of utilization management, the nurse is able to assess a patient's level of care after review of the medical re ...

The Insurance Support Nurse participates in the timely management of denials that are received in the Care Coordination Department.Through sound knowledge of utilization management, the nurse is able to assess a patient's level of care after review of the medical record. · ...

Mass General Brigham relies on a wide range of professionals to advance its mission. The Fraud Analyst builds data analytics for MGB Health Plan's Special Investigations Unit; this role uses data analytics for the SIU to find fraud leads. · Job Summary · The role will create anal ...

Site: Mass General Brigham Incorporated · 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, teac ...

Site: 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 ca ...

The Collections Representative is responsible for communicating with patients, · insurance companies, and other parties to collect outstanding balances, · resolve billing disputes, and ensure proper reimbursement for the hospital.Monitor · & manage the accounts receivable of the ...

Evaluating and analyzing group insurance experience and community-rated fully and self-insured accounts is responsible. Assessing financial and operational aspects of group insurance proposals to determine coverage eligibility pricing terms is involved. The role operates with min ...