Claims Production Specialist

Baystate Health’s Health New England is seeking a detail-oriented Claims Production Specialist to join the Claims team in Springfield, MA. The Claims Production Specialist supports accurate and timely processing, adjustment, recovery, and finalization of medical claims. As part of the Claims Production Team, you’ll help ensure claims are processed in accordance with established policies, quality standards, and regulatory requirements while contributing to efficient operations and positive provider experiences.

• Drive Claims Accuracy: Review and finalize medical claims, adjustments, and retractions in accordance with established policies and procedures.
• Solve Problems: Investigate pending claims, research discrepancies, and coordinate with claims adjudication partners and vendors to resolve issues.
• Support Quality and Performance: Meet productivity and accuracy goals while helping the team deliver consistent, high-quality results.
• Recognize unusual claims trends, processing variations, and potential issues, escalating findings to senior team members.
• Collaborate Across Teams: Partner with Senior Claims Production Specialists, Finance, ASO, and external vendors to resolve claims issues and process provider refunds.
• Manage incoming claims inquiries and requests accurately and within established timelines.
• Protect Data and Compliance: Maintain confidentiality, follow regulatory requirements, and uphold HNE’s commitment to ethical business practices.

Full-time

• 7:00am-3:30pm, Monday through Friday
• No weekends, no holidays

Fully Remote Opportunity – Candidate MUST live in MA or CT 3+ years of experience in healthcare claims administration, medical claims processing, provider billing, or provider payment posting and reconciliation, required

• High school diploma or equivalent, required
• Knowledge of medical coding and billing methodologies, including CPT-4, ICD-10, UB-04, and HCFA-1500.
• Familiarity with healthcare regulations and payer requirements, including HIPAA, ACA, CMS, MassHealth, and ERISA.
• Experience with claims processing systems, medical claims editing platforms, or medical pricing tools.
• Proficiency in Microsoft Word, Excel, and Outlook.

~ High School Diploma (Required) Certifications: Pay ranges are listed as hourly for non-exempt employees and based on assumed full time commitment for exempt employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.