Nov 5 • General discussion
NON PHONE CLAIMS
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
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NON PHONE CLAIMS
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