DSNP Claims Review Specialist — Remote

Partner's Healthcare; Somerville (MA); Remote; USD 24,000 - 35,000; Full time

Benefits offered by this job

Flexible work options

HIPAA-compliant remote workspace

Job summary

Mass General Brigham Health Plan Holding Company, Inc. is seeking an experienced claims processor to adjudicate and process health insurance claims in a high-volume environment.

The role emphasizes applying benefits, verifying pricing, and researching discrepancies to ensure accurate and timely payments. Remote work is available with a flexible benefits package and opportunities for growth.

Qualifications

• Knowledge of healthcare claims processes (D-SNP/fully-integrated Medicare & Medicaid/Mass Health).
• Knowledge of ICD-10, HCPCS, CPT-4 and Revenue Codes.
• Knowledge of medical terminology.
• Familiarity with insurance plans, government programs and their billing requirements.
• Knowledge of claim forms (professional and facility).
• Professional Coder Certificate is desirable.
• Strong customer service orientation and ability to handle sensitive situations with empathy and professionalism.

Responsibilities

• Adjudicate claims to pay, deny, or pend as appropriate in a timely and accurate manner per policy.
• Review and research assigned claims across multiple systems, verifying pricing and contracts.
• Enter claims into processing systems as needed.
• Ensure proper benefits are applied to each claim according to procedures.
• Collaborate with external departments to resolve errors or issues.
• Learn new systems and training resources to apply claims processes.
• Meet performance goals for productivity, accuracy and attendance.
• Maintain records in the call tracking system and other reporting.
• Stay up-to-date with procedures and apply knowledge to processing and customer service.
• Identify and escalate system, configuration, pricing issues promptly.

Skills

Healthcare claims processing

ICD-10 knowledge

Medical terminology

Insurance plans / billing requirements

Claim forms (professional and facility

Strong customer service orientation

Education

Professional Coder Certificate

High School Diploma or equivalent

Job description

Mass General Brigham Health Plan Holding Company, Inc. is seeking an experienced claims processor to adjudicate and process health insurance claims in a high-volume environment.

The role emphasizes applying benefits, verifying pricing, and researching discrepancies to ensure accurate and timely payments. Remote work is available with a flexible benefits package and opportunities for growth.