Medicare Appeals Assistant

Site: Mass General Brigham Health Plan Holding Company, Inc.<p style="text-align:inherit"><br> </p><p style="text-align:left">Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.</p><p style="text-align:inherit"><br> </p><p style="text-align:left"><u><b>Job Summary</b></u></p>Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.<br><br>Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills. <br><br>We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more.<br><br>Responsible for supporting the Medicare appeals and claims resolution process, ensuring timely submission and follow-up on appeals. Assists with gathering documentation, tracking case statuses, and coordinating communications between departments to ensure the accurate handling of claims. The ideal candidates can distinguish an inquiry, coverage request, appeal, claims dispute, and grievance to tirage, which means being able to identify what an expedited request is. The ideal candidate has experience in QNXT and Epic.<br><br>Essential Functions<br>-Prepares and submits appeal documents and claims-related materials to insurance providers and other stakeholders. <br>-Maintains organized records of all appeals and claim-related communications and case statuses. <br>-Coordinates with billing and claims teams to ensure proper documentation for appeals. <br>-Assists with follow-up on pending appeals and communicates status updates to relevant parties.<br>-Supports the preparation of reports on appeals activity, trends, and outcomes. <br>-Handles correspondence related to appeals, including letters, forms, and supporting documentation. <br>-Monitors appeal deadlines and ensure timely submission and follow-up. <br>-Provides administrative support to the billing/claims team and other departments as needed.<p style="text-align:inherit"><br> </p><div><div><div><div><div><div><div><p style="text-align:left"><u><b>Qualifications</b></u></p></div></div></div></div></div></div></div><p><b>Education</b></p><ul><li>High School Diploma or Equivalent required</li></ul><p><br><b>Experience</b></p><ul><li>At least 1-2 years of appeals and grievances experience required</li><li>Medicare appeals/greivances is highly preferred</li><li>At least 1-2 years of claims setting preferred</li></ul><p><br><b>Knowledge, Skills, and Abilities</b></p><ul><li>Proficient organizational and time-management skills.</li><li>Effective written and verbal communication abilities.</li><li>Proficient in Microsoft Office and other billing software.</li><li>Attention to detail and accuracy in document preparation.</li><li>Ability to handle multiple tasks and work efficiently in a fast-paced environment.</li></ul><p style="text-align:inherit"><br> </p><div><div><div><div><div><div><div><p style="text-align:left"><u><b>Additional Job Details (if applicable)</b></u></p></div></div></div></div></div></div></div><p><b>Working Conditions</b></p><ul><li>This is a remote role with a Monday through Friday, 8:30 AM to 5:00 PM schedule</li></ul><p style="text-align:inherit"><br> </p><div><div><div><div><div><div><div><p style="text-align:left"><u><b>Remote Type</b></u></p></div></div></div></div></div></div></div>Remote<p style="text-align:inherit"><br> </p><div><div><div><div><div><div><div><p style="text-align:left"><u><b>Work Location</b></u></p></div></div></div></div></div></div></div>399 Revolution Drive<p style="text-align:inherit"><br> </p><div><div><div><div><div><div><div><p style="text-align:left"><u><b>Scheduled Weekly Hours</b></u></p></div></div></div></div></div></div></div>40<p style="text-align:inherit"><br> </p><div><div><div><div><div><div><div><p style="text-align:left"><u><b>Employee Type</b></u></p></div></div></div></div></div></div></div>Regular<p style="text-align:inherit"><br> </p><div><div><div><div><div><div><div><p style="text-align:left"><u><b>Work Shift</b></u></p></div></div></div></div></div></div></div>Day (United States of America)<p><br><br> </p><p><u><b>Pay Range</b></u></p>$19.81 - $28.30/Hourly<p><br> </p><p><u><b>Grade</b></u></p>3<p><br> </p>At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.<p><br> </p><div><div><div><div><div><div><div><p style="text-align:left"><u><b>EEO Statement:</b></u></p></div></div></div></div></div></div></div>8925 Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. 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. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.<p style="text-align:inherit"><br> </p><h2><u><b>Mass General Brigham Competency Framework</b></u></h2><div><div><p style="text-align:left">At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.</p></div></div>