<p>Site: Mass General Brigham Health Plan Holding Company, Inc.</p> <p>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>Job Summary</p> <p>This role supports the accurate and effective implementation of benefits across all products. It's primarily responsible for benefit configuration and ensuring the configuration aligns with business requirements. Acting as a subject matter expert, the incumbent will work on projects, committees, and workgroups to contribute to business discussions and developments.</p> <p>Essential Functions</p> <ul> <li>Evaluate benefit configuration in collaboration with IT Configuration and Claims staff, ensuring that benefit configuration aligns with the approved business requirements and plan materials. </li><li>Contribute to business discussions regarding benefit coverage and configuration, drawing on claims experience, knowledge of regulatory requirements, industry standards regarding coding and billing, and payer benchmarking for ad hoc and system-wide decisions. </li><li>Represent Benefits Administration as a subject matter expert on corporate projects, committees, or workgroups. </li><li>Provide technical business summaries on selected benefit topics in support of work required to develop and maintain benefits as required for specific program and plan requirements. </li><li>Provide research and benchmarking on services and items represented by new codes as released quarterly, leading the code load process, including the presentation at the Benefit & Coding Committee and business requirements submission to IT Configuration. </li><li>Contribute to benefit property development or modification in the integrated care administrative transaction system by coordinating business requirements with configuration requirements. </li></ul> <p>Qualifications</p> <p>Education</p> <ul> <li>Associate's degree required </li></ul> <p>Experience</p> <ul> <li>At least 3-5 years of experience in a related role required </li><li>At least 3-5 years of experience in valuing the impact of benefit coverage decisions with the support of analytics required </li></ul> <p>Knowledge, Skills, and Abilities</p> <ul> <li>Strong knowledge of ICD-10, CPT, and HCPCS coding systems, as well as insurance verification and authorization processes. </li><li>Familiarity with healthcare revenue cycle management, including claims processing, denial management, and reimbursement methodologies. </li><li>Excellent analytical, organizational, and problem-solving skills, with a strong attention to detail. </li><li>Effective communication and interpersonal skills, with the ability to work collaboratively with various teams. </li><li>Ability to stay current with changes in coding standards, payer requirements, and healthcare regulations. </li></ul> <p>Additional Job Details (if applicable)</p> <p>Working Conditions</p> <ul> <li>This is a remote role that can be done from most US states </li><li>This role is 40 hours/week with five 8-hour days, with a typical schedule of 8:30 am to 4:30 pm </li></ul> <p>Remote Type</p> <p>Remote</p> <p>Work Location</p> <p>399 Revolution Drive</p> <p>Scheduled Weekly Hours</p> <p>40</p> <p>Employee Type</p> <p>Regular</p> <p>Work Shift</p> <p>Day (United States of America)</p> <p>Pay Range</p> <p>$62,400.00 - $90,750.40/Annual</p> <p>Grade</p> <p>6</p> <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> <p>EEO Statement:</p> <p>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> <p>Mass General Brigham Competency Framework</p> <p>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>