Job Information
Tufts Medicine Lead Billing Specialist, Professional Billing (Hybrid) in Lowell, Massachusetts
Hours: 40 hours per week; Monday through Friday from 8:00 AM to 4:30 PM
Location: Hybrid model; 2 days onsite at 55 Technology Drive in Lowell, MA is required.
Job Profile Summary
This role focuses on activities related to revenue cycle operations such as billing, collections, and payment processing. In addition, this role focuses on performing the following Billing related duties: Bills patients for administered care, handles incoming payments, calculates patient intake costs, and tracks accounts receivable to ensure accuracy. Responsibilities also include working with patients to arrange special payment options when necessary. An organizational related support or service (administrative or clerical) role or a role that focuses on support of daily business activities (e.g., technical, clinical, non-clinical) operating in a “hands on” environment. The majority of time is spent in the delivery of support services or activities, typically under supervision. A specialist level role that requires very advanced knowledge of operational procedures and tools obtained through extensive work experience and may require vocational or technical education. Works under limited supervision for non-routine situations and may be responsible for leading daily operations, and trains, delegates and reviews the work of lower level employees, and problems are typically difficult and non-routine but not complex.
Job Overview
This position is responsible for monitoring work volume, creating workflows, identifying trends and escalation needs as well as training/coaching their team on billing and accounts receivable responsibilities. Performs accounts receivables resolution, including but not limited to, registration and eligibility verification, claim edits, payer follow-up, correspondence review, corrected claims, appeals, reimbursement verification, and remittance research for assigned scope of receivables.
Job Description
Minimum Qualifications:
High school diploma or equivalent.
Three (3) years of experience in a hospital billing and collection environment for a medical services provider or third-party payor.
Preferred Qualifications:
Completion of a medical terminology course and understanding of CPT and ICD diagnosis coding.
Certified Revenue Cycle Representative (CRCR).
Epic certifications.
Five (5) years of experience in a hospital billing and collection environment for a medical services provider or third-party payor.
Duties and Responsibilities : The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list. Other duties and responsibilities may be assigned.
Prepares and holds training sessions with billing team and prepare for and attend meetings as requested by supervisor and manager.
Monitors of work volumes in conjunction with supervisors as needed if a training/system issue/escalated account arises.
Identifies trends in workflows and rework, and reports outstanding operational issues to management for further research and resolution.
Provides first point of guidance to billing team/s as needed on billing and follow-up workflow.
Oversees denials, rebills, claim edits by keeping track of denial workflows (rebills, voids, write off, etc.)
Proactively follows-up on all escalated accounts to ensure timely resolution; submits corrected claims and appeals on administrative denials as required.
Responsible for correspondence workflows to ensure the team takes appropriate actions
Performs day-to-day activity to ensure that all information for proper billing is complete and accurate; billing to assigned payers is transmitted or mailed within a timely manner.
Conducts follow-up on outstanding account balances with assigned receivables and takes appropriate action for resolution.
Responsible for researching and handling rejections, including understanding why a claim rejected, how it must be fixed, and what party is financially responsible. Must initiate any corrective action, including referral to the Team Lead or Supervisor when appropriate.
Reviews, evaluates and processes appeals through research and resubmission to appropriate third party with complete and accurate supporting documentation.
Responsible for the processing of adjustments due to denials and contractual requirements.
Resolves assigned accounts in a timely and accurate manner, maximizing reimbursement in compliance with assigned payer and government regulations, and provider organization and department policies and procedures.
Maintains up-to-date knowledge of federal and state regulations and payer requirements along with annual updates to CPT/ICD-10 coding guidelines.
Interacts on a daily basis over the phone, on the web and through correspondence with payers. Establishes working relationships with payer representatives to facilitate processing of claims.
Interacts with other departments of the provider organization using electronic system tools to resolve accounts, including Patient Access, Revenue Integrity, Coding, Medical Records, Utilization Review, Hospital Departments, Physician’s Offices, and other Administrative teams.
Consistently achieves and maintains performance standards for assigned productivity, collections, and quality targets.
Physical Requirements:
Professional office environment with typical office requirements such as computers, phones, photocopiers, filing cabinets, etc.
Frequently required to speak, hear, communicate and exchange information.
Able to see and read computers displays, read fine print, and/or normal type size print and distinguish letters, numbers and symbols.
Occasionally lift and/or move up to 25 pounds.
Ability to work in confined or open environments.
Ability to work independently or in a team environment.
Skills & Abilities:
Working knowledge of hospital billing requirements for assigned payers and/or service specialties.
Working knowledge of the application of Commercial, Blue Cross, Medicare, Medicaid, Managed Care, and other third party payor rules, regulations, guidelines and requirements for billing, collection and reimbursement.
Ability to learn PC based computer systems, word processing, database and spreadsheet software programs.
Proficient in using computers and navigating through third party application systems and web portals efficiently and effectively.
Technically savvy with use of accounts receivables systems and related applications, email, and spreadsheets.
Good interpersonal and communication skills and a basic understanding of team management concepts. Good interpersonal skills in written and verbal form.
Ability to systematically analyze problems, draw relevant conclusions and devise appropriate course of action.
Ability to analyze data, perform multiple tasks and work independently.
Must be able to develop and maintain professional, service-oriented working relationships with senior leadership, patients, physicians, co-workers and employees.
Ability to work in a fast-paced environment, with focus on team building and productivity.
Tufts Medicine is a leading integrated health system bringing together the best of academic and community healthcare to deliver exceptional, connected and accessible care experiences to consumers across Massachusetts. Comprised of Tufts Medical Center, Lowell General Hospital, MelroseWakefield Hospital, Lawrence Memorial Hospital of Medford, Care at Home - an expansive home care network, and large integrated physician network. We are an equal opportunity employer and value diversity and inclusion at Tufts Medicine. Tufts Medicine does not discriminate on the basis of race, color, religion, sex, sexual orientation, age, disability, genetic information, veteran status, national origin, gender identity and/or expression, marital status or any other characteristic protected by federal, state or local law. We will ensure that individuals with disabilities are provided 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. Please contact us to request accommodation by emailing us at careers@tuftsmedicine.org .