Medical Billing Specialty Representative-(3309223) - Partners Healthcare System

The Opportunity

Reporting directly to the Manager and under the general direction of the Senior Manager, Specialty Billing, the Billing Representative III performs a wide spectrum of billing functions to minimize accounts receivable, enhance collection performance. This position is relied upon to train staff and work on any activity within the team with little supervision. Utilizes electronic billing and medical retrieval systems and in-depth knowledge of medical billing and insurance rules and regulations to resolve accounts receivable issues. This position serves as the primary resource for the Manager on complex issues and specified duties.

PRINCIPAL DUTIES AND RESPONSIBILITIES

§Achieve excellence in performance by working collaboratively with others on MGB RCO and Enterprise Initiatives

§Supports and demonstrates the values of Massachusetts General Brigham by conducting activities ethically with integrity, honesty, and confidentiality. Demonstrates a positive, open-minded, can-do attitude. Represents a team perspective and willingness and enthusiasm to collaborate with others. Follows through on commitments and achieves desired results. Exhibits sound judgment, obtains the facts, examines options, gains support, and achieves positive outcomes.

§Drives DE&I (Diversity, Equity, & Inclusion) and recognizes the value that different perspectives and cultures bring to an organization.

§Create and foster an atmosphere of continuous improvement.

§Always maintain high professional conduct standards. Represents the MGB RCO at events and projects external to the organization.

§Enthusiastically promote a cooperative team environment to provide value to all customers. Act as a leader in creating a positive atmosphere within the team. Listen and interact tactfully, diplomatically, and effectively without alienating others.

§Develop relationships with all levels to modify/create procedures to reduce backlogs and improve financial performance.

§Perform all aspects of the Billing Representative I & Billing Representative II positions at a consistently high degree of proficiency. This entails a complete understanding of all department policies and procedures to execute all billing tasks with minimal direct supervision. Act with minimal supervision, notice or direction to identify and resolve problems and complete work. This representative is expected to be a leader within the team in productivity, teamwork, efficiency, communication, and the overall patient experience.

§Train and orient staff at the direction of the Manager as needed. Includes maintaining and updating documentation for workflows and work files.

§Function as the ‘go to’ person within the Team for payer and/or specialty specific questions or issues.

§Ability to work onthe most sensitive and/or high-profile patient accounts, projects and/or accounts as directed. Provide immediate feedback to Manager on changes or modifications that need to be communicated to appropriate departments within the MGB RCO.

§Apply expert knowledge of insurance rules and regulations to interpret new insurance/HCFA/HIPAA information and report potential impact. Utilize experience and expertise to determine the correct course of action efficiently and effectively on each account/project.

§Effectively handle telephone inquiries from all customers including patients, insurance companies and other departments within the PBO. Gather and interpret all relevant information to help resolve issues or complaints. Document issues thoroughly.

§Coordinate data to complete special billing projects based on contractual obligations and regulatory demands.

§Apply transfers and/or adjustments to invoices as necessary to complete the resolution of each invoice.

§Request necessary follow-up data via manager as appropriate to resolve issues and trends once identified within their work files and follow through on resolutions to completion.

§Provide detailed summaries of issues/requests with supportive data to management. Recommend resolutions, workflows, and identify root cause. Must be able to exercise proper judgment as necessary and raise issues to the appropriate management level.

§Meet deadlines and exceed both productivity and quality standards for Epic Workqueues, including but not limited to:

1.Insurance verification

2.Referral Management

3.Correspondence & phone inquiries

4.Billing/mailing claims/appeals

5.Working claim edits & scrubbers

6.Third party follow-up including secondary billing & rejections

7.Special projects

§Demonstrate proficiency with a variety of automations, including but not limited to Epic, Microsoft Word, Excel, E-mail, Voicemail and Payor Websites.

§Take a lead role in ongoing quality improvement efforts.Establish goals with Manager and track progress. Comply with hospital confidentiality policy. Manage special projects as assigned.

§Effectively handle complaints and complex calls from patients by defusing the situation and resolving the relevant issues when providing assistance to Customer Service & Self-pay. Utilize collections experience and expertise to determine the correct course of action efficiently and effectively on each account/project.

§Perform other duties as assigned

Qualifications

• High School Diploma or GED equivalent required

• Associates degree or equivalent preferred. Experience may be substituted for a degree.

• Three years experience in high volume medical billing and Billing/Accounts Receivable systems required.

• Epic System knowledge preferred

• Effective communication, organizational and problem-solving skills

• Detailed working knowledge of medical terminology, ICD 10 coding and CPT, HCPCS required.

• Knowledge of medical Billing, insurance rules and regulations required

• Exceptional written and verbal skills

MGB is an Affirmative Action Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a 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.