Sr. Client Operations Specialist

University of Massachusetts Medical School; Westborough (MA); On-site; USD 65,000 - 90,000; Full time

Job summary

University of Massachusetts Medical School seeks a Sr. Client Operations Specialist to compile and submit claims for federal, state, or private reimbursement on behalf of contracted providers.

You will use internal systems and insurance portals to capture data, verify eligibility, resolve rejections, and monitor denials and payments. You will join the Federal Claiming unit, supporting school-based health, laboratory or vaccine administration services, and serve as the primary contact and SME for

Qualifications

• Bachelor's Degree or equivalent work experience.
• 3–5 years in medical billing support, customer service or program coordination.
• Proficient in Microsoft Excel; also Word, Outlook and Teams.
• Strong verbal and written communication skills.
• Able to work independently to meet objectives; also effective in teams.
• Preferred: federal claiming or medical billing experience; familiarity with RMTS.

Responsibilities

• Review service data for discrepancies and verify with providers.
• Validate data and check insurance eligibility via portals.
• Process claims data using internal systems.
• Monitor payments, denials, and identify trends.
• Troubleshoot issues to ensure timely processing.
• Serve as primary contact for clients and provide SME support.
• Update and disseminate program documents and procedures.
• Educate clients on program requirements and reimbursement opportunities.
• Collaborate with team to ensure timely client responses.
• Stay informed on regulatory changes affecting reimbursement.
• Participate in testing billing system upgrades.

Skills

Communication skills

Independent work

Team collaboration

Education

Bachelor's Degree or equivalent

Tools

Microsoft Excel

Microsoft Word

Outlook

Teams

Job description

Overview

Under the general direction of the Department Manager or designee, the Sr. Client Operations Specialist will be responsible for compiling and submitting claims for eligible health care and other services or expenditures for private, state, or federal reimbursement on behalf of contracted clients with required deadlines. The Sr. Client Operations Specialist will utilize internal systems and insurance portals to capture service and expenditure data, verify insurance eligibility, resolve rejections, and monitor denials and payments.

The Sr. Client Operations Specialist will work within the Federal Claiming unit that specializes in the configuration of technical solutions and provides expertise and resources to local governmental agencies for the purposes of seeking federal reimbursement for eligible expenditures and services. Currently this unit provides medical billing or claiming solutions and support to over 250 contracted providers of school-based health, laboratory, or vaccine administration services.

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.

Qualifications

REQUIRED EDUCATION:

Bachelor's Level Degree or equivalent work experience

REQUIRED WORK EXPERIENCE:

• 3-5 years of related experience including but not limited to medical billing support, customer service, program coordination or administration
• Strong proficiency with Microsoft Excel
• Proficiency with other essential Microsoft Office applications (Word, Outlook, Teams)
• Strong oral and written communication skills
• Demonstrated ability to work independently to achieve objectives
• Work effectively in both team and individual environments

PREFERRED WORK EXPERIENCE:

• Federal claiming or medical billing experience
• Familiarity with Random Moment Time Study or other cost allocation tools.