Federal Claims & Client Operations Lead

UMass Chan Medical School; Westborough (CA); On-site; USD 70,000 - 95,000; Full time

Job summary

UMass Chan Medical School in the United States is seeking a Sr. Client Operations Specialist to compile and submit healthcare claims for private, state, or federal reimbursement on behalf of contracted clients.

The role uses internal systems to capture data, verify eligibility, resolve rejections and monitor denials to ensure timely payments. The ideal candidate will have 3–5 years in medical billing or related coordination, strong Excel skills and the ability to work independently and with

Qualifications

• Bachelor's level degree or equivalent work experience.
• 3-5 years of related experience including medical billing support, customer service, program coordination or administration.
• Proficiency with Microsoft Excel and other Office apps.
• Strong oral and written communication skills.

Responsibilities

• Carefully review and analyze service or expenditure data provided by health care providers for discrepancies and/or missing data.
• Promptly validate data with providers, as appropriate.
• Verify insurance eligibility using insurance portals and prioritize liability by primary and secondary insurance.
• Review service claims held or rejected for missing data or incomplete elements.
• Process health care service and expenditure data required using internal systems.
• Analyze and monitor data, payments or denials to identify possible programmatic trends or issues.
• Troubleshoot issues to ensure timely processing of claims.
• Escalate issues appropriately, including gathering and providing detailed documentation to support and explain the issues.
• Serve as primary contact, representative, and subject matter expert to assigned clients.
• Review, maintain, update and disseminate program documents including reports, client information, manuals, and procedures.
• Provide ongoing outreach, education and communication to clients regarding program requirements, revenue performance and reimbursement opportunities.
• Collaborate with other team members to effectively and efficiently ensure customers receive timely responses.
• Keep abreast of any regulatory or program changes impacting requirements for reimbursement.
• Participate in testing of billing system upgrades or new applications, including suggesting and identifying areas for functionality improvements.

Skills

Strong communication

Independent worker

Team collaboration

Attention to detail

Education

Bachelor's Degree or equivalent

Tools

Microsoft Excel

Microsoft Word

Outlook

Teams

Job description

UMass Chan Medical School in the United States is seeking a Sr. Client Operations Specialist to compile and submit healthcare claims for private, state, or federal reimbursement on behalf of contracted clients.

The role uses internal systems to capture data, verify eligibility, resolve rejections and monitor denials to ensure timely payments. The ideal candidate will have 3–5 years in medical billing or related coordination, strong Excel skills and the ability to work independently and with