Medicare Advantage Claims Quality Control Reviewer

Mass General Brigham Health Plan Holding Company, Inc.

Somerville, MA, United States
$25.50 - $36.49phly; not specified; not specified
Fully remote
Medicare advantage claims processing
Claims entry and processing
Claims processing errors
This role supports the quality control of claims entry and processing to identify claims processing errors and remediation prior to payment or denial

Job Summary

  • This role supports the quality control of claims entry and processing to identify claims processing errors and remediation prior to payment or denial.
  • Responsible for end-to-end pre-pay review of claims adjudicated in QNXT to ensure complete and accurate claims processing in alignment with Medicare regulations.
  • 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.

Matching Summary

This role supports the quality control of claims entry and processing to identify claims processing errors and remediation prior to payment or denial.

Salary

$25.50 - $36.49/Hourly; Not specified; Not specified

Skills & Requirements

Must-have

  • Medicare Advantage claims processing
  • claims entry and processing
  • claims processing errors
  • pre-pay review of claims
  • post-pay review of Explanations of Payments
  • trend analysis and root cause review

Nice-to-have

  • groundbreaking medical discoveries
  • exceptional care
  • collaboration with multifaceted teams

Key Requirements

  • 2-3 years quality control experience
  • 2-3 years healthcare experience
  • 2-3 years Medicare Advantage claims processing
  • 2-3 years MassHealth claims processing preferred
  • Bachelor's Degree preferred
  • AAPC certification(s) a plus

Work Rights

Not specified

Tailored Resume

Cover Letter