What are the responsibilities and job description for the Supervisor of DSNP Claims position at Mass General Brigham Health Plan?
Responsible for overseeing a team that assesses healthcare (D-SNP/fully-integrated Medicare & MassHealth/Medicaid) claims for accuracy, compliance, and eligibility, ensuring that claims are processed efficiently and in accordance with industry standards, Medicare and MassHealth/Medicaid regulatory requirements, and organizational policies. This position will guide and support the D-SNP claims review team, handle escalations, and collaborate with other departments to improve claims processing and ensure timely reimbursements.
Essential Functions
-Supervise and manage a team of D-SNP claims reviewers to ensure accurate and timely healthcare D-SNP/fully-integrated Medicare & MassHealth/Medicaid claims processing.
-Oversee D-SNP claims review and analysis to ensure compliance with Medicare and MassHealth/Medicaid regulations, payer requirements, and organizational policies.
-Resolve escalated or complex D-SNP claims issues, ensuring appropriate adjudication and dispute resolution.
-Monitor team performance, provide feedback, and conduct regular evaluations to support professional growth.
-Implement and enforce policies and procedures to streamline the D-SNP claims review process for greater accuracy and efficiency.
-Collaborate with billing, coding, and compliance teams to ensure adherence to Medicare and MassHealth/Medicaid regulatory and payer standards.
-Analyze D-SNP claims data to identify trends, address issues, and recommend process improvements.
-Provide training, guidance, and ongoing education for new and existing team members on industry changes and standards.
-Performs other duties as assigned.
-Complies with all policies and standards.
Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.
Our promise as a people-first organization starts with our employees. AllWays Health Partners is committed to diversity, equity, and inclusion in our workforce, internal culture, and investments. As an equal opportunity employer, AllWays Health Partners recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives, and backgrounds.
Education
- Bachelor's Degree or equivalent years of experience required
Experience
- Experience in healthcare claims review or processing for D-SNP/fully-integrated Medicare & MassHealth/Medicaid beneficiaries
- At least 1-2 years of experience in a senior or leadership role 1-2 required.
Knowledge, Skills, and Abilities
- Strong knowledge of healthcare claims processes (D-SNP/fully-integrated Medicare & Medicaid/MassHealth), coding (CPT, ICD-10), and payer regulations.
- Excellent leadership, communication, and problem-solving skills.
- Proficiency in claims processing software and healthcare management systems (Facets/QNXT preferred).
- Strong attention to detail and the ability to manage multiple tasks and priorities.
Working Conditions
- This is a hybrid role and will include onsite meetings 1-2x/month
Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.
Our promise as a people-first organization starts with our employees. AllWays Health Partners is committed to diversity, equity, and inclusion in our workforce, internal culture, and investments. As an equal opportunity employer, AllWays Health Partners recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives, and backgrounds.
