Medicare/Medicaid Claims Reimbursement Specialist ‼️Non Phone | Resume Template Available ‼️ - validation. - Escalate systemic or high-impact discrepancies to the Director of Claims Operations and Quality Assurance for further investigation or configuration updates. - Document all research, findings, and outcomes in claims systems (e.g., Salesforce, Facets) in compliance with audit standards and MassHealth requirements. - Maintain awareness of MassHealth transmittals, billing guides, and program updates to ensure adherence in payment practices. - Ensure SLA compliance for inquiry resolution, appeal response times, and post-payment audits. - Assist in the resolution of complex provider disputes and escalations, including direct support to leadership in pricing determinations and dispute case documentation. Working Conditions: - Standard office conditions. Required Education (must have): - N/A