Remote Healthcare Claims Integrity Auditor

8925 Mass General Brigham Health Plan Holding Company, Inc.; Somerville (MA); Remote; USD 24,000 - 35,000; Full time

Job summary

Mass General Brigham Health Plan Holding Company, Inc. is seeking a Claims Review Specialist to assess and audit medical claims for accuracy and compliance.

You will validate ICD-10 and CPT codes, ensure complete documentation, and verify payments against contracts and industry benchmarks. The role emphasizes attention to detail, knowledge of HIPAA, and strong communication with providers, insurers, and patients.

Qualifications

• Knowledge of medical billing and coding principles, reimbursement methodologies, and insurance claim submission processes.
• Knowledge of healthcare regulations and compliance, including HIPAA guidelines.
• Familiarity with insurance plans, government programs, and their billing requirements.
• Strong attention to detail and accuracy in claim submissions and recordkeeping.
• Excellent communication skills, both written and verbal, to interact effectively with insurance companies, patients, and colleagues.
• Strong customer service orientation and ability to handle sensitive or difficult situations with empathy and professionalism.

Responsibilities

• Review and assess medical claims submitted by healthcare providers, insurance companies, and patients to identify discrepancies, errors, or potential fraud.
• Analyze and validate the assigned diagnosis codes (ICD-10) and procedure codes (CPT) on medical claims to ensure accurate representation of the services rendered.
• Ensure that the medical claims include complete and accurate documentation supporting the services rendered, including physician notes, test results, and other relevant records.
• Analyze claim payment amounts and compare them to contracted rates, fee schedules, and industry benchmarks.
• Identify underpayments, overpayments, and potential billing errors.
• Conduct comprehensive audits of medical claims to verify compliance with billing regulations, payer policies, and internal policies and procedures.
• Stay updated on insurance company policies, billing guidelines, and reimbursement rules.

Skills

Medical billing

HIPAA

Attention to detail

Communication skills

Education

High School Diploma or Equivalent

Associate's Degree preferred

Job description

Mass General Brigham Health Plan Holding Company, Inc. is seeking a Claims Review Specialist to assess and audit medical claims for accuracy and compliance.

You will validate ICD-10 and CPT codes, ensure complete documentation, and verify payments against contracts and industry benchmarks. The role emphasizes attention to detail, knowledge of HIPAA, and strong communication with providers, insurers, and patients.