Claims Review Specialist, Dsnp

Mass General Brigham Health Plan Holding Company, Inc.

Not specified, Not specified, US
Base: $17.71 - $25.28phly; bonus/equity: not speci...
Fully remote
Sco and one care claims processing
Qnxt or similar claims adjudication systems
Review and research assigned claims
Mass General Brigham Health Plan is at the forefront of transformation with one of the world’s leading integrated healthcare systems, providing innovative solutions centered on member health needs

Job Summary

  • Mass General Brigham Health Plan is at the forefront of transformation with one of the world’s leading integrated healthcare systems, providing innovative solutions centered on member health needs.
  • The D-SNP Claims Review Specialist reviews and processes Senior Care Options (SCO) and One Care medical claims requiring manual intervention when auto-adjudication is not achieved.
  • We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more.

Matching Summary

Mass General Brigham Health Plan is at the forefront of transformation with one of the world’s leading integrated healthcare systems, providing innovative solutions centered on member health needs.

Salary

Base: $17.71 - $25.28/Hourly; Bonus/Equity: Not specified; Benefits: Comprehensive benefits package

Skills & Requirements

Must-have

  • SCO and One Care claims processing
  • QNXT or similar claims adjudication systems
  • Review and research assigned claims
  • Manual claims entry
  • Apply proper benefits to claims

Nice-to-have

  • Strong customer service orientation
  • Handle sensitive situations with empathy
  • Collaborate with external departments
  • Leverage new systems and training

Key Requirements

  • 1-2 years related healthcare experience
  • 2-3 years health insurance industry experience
  • Associate's Degree Healthcare Management preferred
  • Knowledge of ICD-10, HCPCS, CPT-4
  • Professional Coder Certificate highly desirable

Work Rights

Not specified

Tailored Resume

Cover Letter