Revenue Cycle Specialist III - East Boston Neighborhood Health Center Corporation

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Everywhere you turn, you can feel it.  There's an immeasurable level of enthusiasm at East Boston Neighborhood Health Center (EBNHC), one of the largest community health centers in the country.  From the nurses and physicians on the front line of patient care, to the managers who shape our policies, to the customer service representatives who keep our facilities running smoothly - everyone here has a role in making medicine better.

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Description:

Reporting directly to department manager and under the general direction of the Lead Biller, the EBNHC Revenue Cycle Specialist performs a wide spectrum of billing functions to minimize accounts receivable and enhance collection performance. This position is relied upon to train staff and work on any activity within the team with little supervision. Utilize electronic medical billing systems as well as in depth advanced knowledge of medical billing and insurance rules and regulations to resolve accounts receivables issues. This position serves as the primary resource on complex issues and specified duties.

Essential Duties & Responsibilities

• Meet deadlines and productivity standards for Epic work queues, including but not limited to: Insurance verification (Epic RTE), Denials (research root cause, identify trends, correct, appeal), Claim Edits (ensure clean claim submission) & Transaction history (track claim submission and payor response)
• Work the priority Epic work queues , projects and/or accounts and provide immediate feedback to management.
• Utilize payor websites to research policies and coverage eligibility for use in claim adjudication, trend identification, and application for process improvement.
• Utilize MS Office, with an emphasis on Excel to document, trend, and communicate workflow assignments, trends, and information vital to performance.
• Apply transfers and/or adjustments to invoices as necessary to complete the resolution of each invoice.
• Knowledge of ICD-10, Modifiers,Revenue Codes, HCPCS and CPT codes.
• Coordinate data to complete special billing projects based on contractual obligations and regulatory demands.
• Apply knowledge of insurance rules and regulations to interpret new insurance/HCFA/UB/HIPAA information and report potential impact.
• Work along EBNHC Patient Accounts Leadership with various payors as part of the contact group responsible for updates and information required to assist others in the organization.
• Participation in various projects and testing of updates for evaluation and implementation.

EDUCATION: High School Diploma or equivalent.

EXPERIENCE: 

• 3+  years of experience in a medical billing
• 3+ years of Epic PB Resolute experience required
• Demonstrate proficiency with a variety of automations, including but not limited to Epic, Microsoft Word, Excel, Email and electronic data processing skills
• Working knowledge of insurance rules and regulations
• Proficiency in PC software (i.e database)
• Ability to manage multiple tasks/projects simultaneously

SKILLS/ABILITIES:

• Proficiency level understanding of Medical Billing, ICD and CPT coding preferred.
• Strong organizational skills and effective interpersonal skills
• Excellent communication skills (verbal and written)