[Hiring] Supervisor, Medicaid Claims Reviewer @Mass General Brigham

Role Description

The Supervisor, Medicaid Claims Review is responsible for leading a high-performing team focused on Medicaid claims quality, payment accuracy, and adjudication integrity. This role oversees daily inventory management while driving continuous improvement through denial trend analysis, high-dollar claim oversight, and proactive identification of adjudication risks. The Supervisor partners cross-functionally with Configuration, Reimbursement Strategy, Pharmacy Operations, and Payment Integrity to strengthen claims outcomes and reduce rework across the enterprise.

• Supervise and manage a team of claims reviewers to ensure accurate and timely healthcare claims processing.
• Oversee claims review and analysis to ensure compliance with healthcare regulations, payer requirements, and organizational policies.
• Resolve escalated or complex 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 claims review process for greater accuracy and efficiency.
• Collaborate with billing, coding, and compliance teams to ensure adherence to regulatory and payer standards.
• Analyze 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.
• Perform other duties as assigned.
• 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.

Qualifications

• Bachelor's degree required (experience can be considered in lieu of degree).
• Certified Professional Coder (CPC) preferred.
• At least 3-5 years of experience in healthcare claims review or processing required.
• At least 1-2 years of experience in a senior or leadership role required.
• Strong knowledge of healthcare claims processes, coding (CPT, ICD-10), and payer regulations.
• Excellent leadership, communication, and problem-solving skills.
• Proficiency in claims processing software and healthcare management systems.
• Strong attention to detail and the ability to manage multiple tasks and priorities.

Requirements

• This is a full-time role with a Monday through Friday, 8:30-5:00 PM Eastern Time schedule.
• This is a remote role that can be done from most US states.
• Remote workdays require a stable, secure, quiet, and HIPAA-compliant workspace.
• Scheduled Weekly Hours: 40.
• Employee Type: Regular.
• Work Shift: Day (United States of America).
• Pay Range: $79,560.00 - $115,720.80/Annual.
• Grade: 7.

Benefits

• Competitive salaries.
• Flexible work options.
• Career growth opportunities.
• Comprehensive benefits package.
• Recognition programs designed to celebrate your contributions and support your professional growth.