Sr. Client Operations Specialist

UMass Chan Medical School; Westborough (MA); On-site; USD 60,000 - 90,000; Full time

Job summary

UMass Chan Medical School in Westborough, MA seeks a Sr. Client Operations Specialist to compile and submit health care claims for federal, state, and private reimbursement.

You will use internal systems and portals to verify eligibility, resolve rejections, and monitor denials to ensure timely payments. As part of the Federal Claiming unit, you will review data accuracy, liaise with providers, and communicate program requirements and reimbursement opportunities.

Qualifications

• 3–5 years of related experience including medical billing support or administration.
• Strong proficiency with Microsoft Excel and core Office apps.
• Excellent written and verbal communication skills.
• Ability to work independently and meet objectives.

Responsibilities

• Review service/expenditure data for discrepancies or missing elements.
• Promptly validate data with providers as appropriate.
• Verify insurance eligibility using portals and prioritize liability.
• Review claims held or rejected for missing data or incompleteness.
• Process health care service data using internal systems.
• Analyze payments/denials to identify trends or issues.
• Troubleshoot issues to ensure timely claim processing.
• Escalate issues with detailed documentation and context.
• Serve as primary contact and SME to assigned clients.
• Review/update program documents, client info, manuals, and procedures.
• Provide ongoing outreach on program requirements and reimbursement opportunities.
• Collaborate with teammates to ensure timely client responses.
• Keep abreast of regulatory/program changes impacting reimbursement.
• Participate in testing of billing upgrades or new applications.

Skills

Strong oral & written communication

Independent work ability

Team and individual work

Education

Bachelor's Degree or equivalent

Tools

Microsoft Excel

Microsoft Word

Outlook

Teams

Job description

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.

• 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.

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.

The University of Massachusetts Chan Medical School welcomes all qualified applicants and complies with all state and federal anti-discrimination laws.