DSNP Claims Resolution Specialist - Remote

your Jared; Somerville, Northern (MA, KY); Hybrid; USD 28,000 - 39,000; Full time

Job summary

Mass General Brigham Health Plan is seeking a DSNP claims resolution coordinator to review, research, and resolve DSNP claim inquiries, provider correspondence, and escalations. You will apply Medicare and Medicaid guidelines to determine adjustments and ensure claims are processed accurately and timely.

This remote, full-time role emphasizes collaboration with Customer Service, Compliance, and Pricing to resolve issues, with strong attention to detail, excellent communication, and a focus on

Qualifications

• Knowledge of medical billing and coding principles, reimbursement methodologies, and insurance claim submission processes.
• Knowledge of healthcare regulations and compliance requirements, including HIPAA guidelines.
• Experience with Medicare/Medicaid and government programs, and strong attention to detail.

Responsibilities

• Review, research, and resolve DSNP claim inquiries, provider correspondence, and escalations.
• Determine appropriate claim action (payment, denial, adjustment, manual entry) per guidelines.
• Validate benefits, authorizations, pricing, and eligibility to support accurate resolution.
• Maintain documentation in tracking systems and call notes.
• Collaborate with Customer Service, Provider Relations, Compliance, and Pricing to resolve issues.
• Identify and escalate system or process issues with supporting detail.

Skills

Medical billing

Coding principles

HIPAA compliance

Healthcare claims

Customer service

Attention to detail

Education

Associate’s degree

Job description

Mass General Brigham Health Plan is seeking a DSNP claims resolution coordinator to review, research, and resolve DSNP claim inquiries, provider correspondence, and escalations. You will apply Medicare and Medicaid guidelines to determine adjustments and ensure claims are processed accurately and timely.

This remote, full-time role emphasizes collaboration with Customer Service, Compliance, and Pricing to resolve issues, with strong attention to detail, excellent communication, and a focus on