Schedule Details:

Scheduled Hours:

Shift:

Hours:

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

At UMass Memorial Health, everyone is a caregiver - regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 16,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.

I. Major Responsibilities:

1. Analyzes and researches failed claim edits and work with departments and payers to resolve the edit within established timeframes, policies and procedures. Uses reference material to troubleshoot edits and gain additional understanding.
2. Escalates trends and additional edits internally, to promote claim accuracy and quality applicable to Hospital Billing Revenue Cycle management system, claim submission system, and payor claims processing systems.
3. Troubleshoots issues, providing root cause analysis and recommends potential solutions.
4. Works with clinical areas as needed to validate data and/or escalate outstanding issues to ensure proper claim submission, reimbursement and resolution.
5. Ensures timely resolution to all accounts receivable utilizing assigned work queues. Follows prioritization standards. Resolves edits in the adjunct claim submission application.
6. Maintains current knowledge and understanding of existing and outstanding accounts receivable including but not limited to payer response times.
7. Updates claim information using Medicare FISS system, Medicaid MMIS and other payer websites.
8. Follows payers established procedures and timelines to submit appeals utilizing payers preferred method, i.e., electronically or via paper.
9. Responds to incoming inquiries from attorneys, payers, employers, etc., following all hospital and regulatory guidelines.
10. Releases patient information following Federal, State, and Hospital guidelines.
11. Corresponds with third party payers, hospital departments, and patients to obtain information required for account receivable resolution.
12. Adjusts account balances using correct transaction code adhering to guidelines.
13. Works with team leader and/or Supervisor on account resolution strategies that optimize reimbursement. Escalates issues timely.
14. Works with Finance department to support contract and state documentation requirements.
15. Using established guidelines, supports documentation needs for payer audit requests.
16. Meets established productivity standards.
17. Facilitates and promotes the sharing of knowledge and content throughout departments.
18. Participates in cross training to optimize department resources.
19. Demonstrates excellent attendance and actively participates in a variety of meetings and training sessions as required.
20. Maintains and fosters an organized, clean and safe work environment.
21. Maintains a collaborative, team relationship with peers and colleagues in order to effectively contribute to the group's achievement of goals and to help foster a positive work environment.
22. Practices cost containment and fiscal responsibility through the efficient use of supplies, equipment, time, etc.

Standard Staffing Level Responsibilities:

1. Complies with established departmental policies, procedures and objectives.
2. Attends variety of meetings, conferences, seminars as required or directed.
3. Demonstrates use of Quality Improvement in daily operations.
4. Complies with all health and safety regulations and requirements.
5. Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.
6. Maintains, regular, reliable, and predictable attendance.
7. Performs other similar and related duties as required or directed.

All responsibilities are essential job functions.

II. Position Qualifications:

License/Certification/Education:

Required:
1. High School diploma

Experience/Skills:

Required:
1. Three or more years of experience in health care billing functions.
2. Previous health care billing experience.
3. Advanced knowledge of specialty billing requirements related to claims and reimbursement policies.
4. Basic clinical knowledge of specialty billing areas including but not limited to Research, Clinical Trials, Client, Transplant, Bone Marrow Transplant, Solid Organ Transplant, and Dental.
5. Ability to work collaboratively and effectively with people.
6. Exceptional communication and interpersonal skills.
7. Ability to work independently, exercise good judgment to ensure compliant claims submission.

Unless certification, licensure or registration is required, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements.

Department-specific competencies and their measurements will be developed and maintained in the individual departments. The competencies will be maintained and attached to the departmental job description. Responsible managers will review competencies with position incumbents.

III. Physical Demands and Environmental Conditions:

Work is considered sedentary. Position requires work indoors in a normal office environment.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

We're striving to make respect a part of everything we do at UMass Memorial Health - for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.

As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.

If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at talentacquisition@umassmemorial.org. We will make every effort to respond to your request for disability assistance as soon as possible.