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.

RESPONSIBILITES

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.

• Identify Opportunities for Improvement: 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.

• Deliver Responsive Service: 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.

SCHEDULE:

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

LOCATION:

• 1 Monarch Place
• Springfield, MA
• Fully Remote Opportunity – Candidate MUST live in MA or CT

QUALIFICATIONS

• 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.
• Strong analytical, critical-thinking, and problem-solving skills.
• Excellent communication and collaboration skills.
• Proficiency in Microsoft Word, Excel, and Outlook.
• A commitment to accuracy, confidentiality, compliance, and continuous learning.

Education:

Certifications:

Compensation

Note: The compensation range(s) in the table below represent the base salaries for all positions at a given grade across the health system. Typically, a new hire can expect a starting salary somewhere in the lower part of the range. Actual salaries may vary by position and will be determined based on the candidate's relevant experience. No employee will be paid below the minimum of the range. Pay ranges are listed as hourly for non-exempt employees and based on assumed full time commitment for exempt employees.

Minimum - Midpoint - Maximum

Equal Employment Opportunity Employer