Mass General Brigham · 1 day ago
Medicare Advantage and DSNP Claims Analyst
United States
Full-time
Remote
Entry, Mid Level
$62K/yr - $91K/yr
2+ years expMass General Brigham is a not-for-profit organization committed to advancing patient care and research. They are seeking a Medicare Advantage and DSNP Claims Analyst responsible for analyzing claims data to support operational decisions and ensure compliance with regulatory requirements.
Health CareHome Health CareMedical
Responsibilities
Collects, monitors and analyzes Medicare Advantage and D-SNP Claims reporting to ensure timeliness, accuracy and compliance internally to support decisions on day-to-day operations, strategic planning, and/or specific business performance issues
Reviews, tracks, and communicates key performance indicators (KPIs) related to regulatory compliance, timeliness, and accuracy
Performs data validation of source-to-target data for data visuals and dashboards
Creates and updates claim reports
Collates, models, interprets, and analyzes data
Identifies trends and explains variances and trends in data, recommends actions, and escalates to leaders as appropriate
Identifies and documents enhancements to modeling techniques
Completes thorough quality assurance procedures, ensuring accuracy, reliability, trustworthiness, and validity of work
Provides audit support, both internal and external, which includes supporting the monthly Claims Compliance Monitoring and Organization Determination, Appeals, and Grievances (ODAG/ODR) reporting processes for all Medicare Advantage and D-SNP contracts
Works closely with internal departments, including but not limited to Enrollment, Customer Service, Reimbursement Strategy, Benefits, Product, Configuration, IT, and Digital Services to ensure seamless coordination and integration for claims data analysis
Collaborate with vendor partners to monitor and analyze claims reporting
Identifies operational inefficiencies or process bottlenecks and recommend improvements to enhance workflows, reduce costs, and improve member and provider satisfaction
Assist with the implementation and management of new medical health plan products or changes to existing plans
Support the creation and maintenance of medical health plan policies, procedures, and workflows to ensure compliance with CMS and EOHHS regulatory requirements
Performs other duties as assigned
Complies with all policies and standards
Qualification
Required
Bachelor's Degree required; experience can be substituted for degree
At least 2-3 years of medical claims processing and/or data analysis within the health insurance or healthcare industry experience required
Medicare experience required
Massachusetts Medicaid experience required
Healthcare knowledge, particularly as it pertains to medical claims processing data, is preferred but not required
Working knowledge of relational databases, SQL, Power BI, data visualization, and business intelligence tools such as Tableau
Knowledge and application of statistical analyses, including variance analysis and statistical significance, are preferred
Project management skills and/or experience are a plus
Proficiency with Microsoft Office Suite, including Word, Excel and PowerPoint
Benefits
Comprehensive benefits
Career advancement opportunities
Differentials
Premiums and bonuses as applicable
Recognition programs designed to celebrate your contributions and support your professional growth
Company
Mass General Brigham
Mass General Brigham specializes in providing medical treatments and health diagnostics services.
10001+ employees
H1B Sponsorship
Mass General Brigham has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (77)
2024 (61)
2023 (93)
2022 (70)
2021 (80)
2020 (29)
Funding
Current Stage
Late StageLeadership Team
E
Erin Flanigan
SVP, Human Resources, Community, Specialty Hospital Division
O’Neil A. Britton
Chief Integration Officer, Executive Vice President
Recent News
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