[Hiring] Accounts Receivable II, Specialty Billing @UMass Memorial Health

Role Description

Responsible for follow-up of complex surgical/procedural/multidisciplinary specialty claims for payments including coding and analyzing claims and claim payments/rejections.

• Contacts insurance companies, while working detailed reports, to secure outstanding payments, i.e. telephone calls, websites, written appeals.
• Reviews complex rejections in assigned payors and plans to determine validity of rejections and take appropriate action to resolve.
• Monitors changes in reimbursement policies, including payor fee schedule reconciliation.
• Performs special projects as assigned by manager or supervisor defining problems, determining work sequence and summarizing findings.
• Calculates and posts adjustments based on third party reimbursement guidelines and contracts.
• Makes appropriate payor and plan changes to secondary insurers or responsible parties.
• Inputs missing data as required and corrects registration and other errors as indicated.

Qualifications

• High School Diploma
• Two years of previous Revenue Cycle knowledge including PFS, Customer Service, Cash Posting, Financial Assistance, Patient Access, HIM/Coding and/or 3rd party reimbursement.
• Knowledge of multiple third-party regulations, ICD, CPT and HCPCS coding and modifier assignment.
• Knowledge of billing and reimbursement practices/requirements of major third-party payors in Massachusetts.
• Knowledge of medical terminology, anatomy & physiology and disease process.
• Ability to organize and prioritize work to meet strict deadlines.
• Computer skills to include mainframe, PC applications and Excel.
• Must be self-motivated, service oriented and have excellent communication skills (written and oral).
• Physician coding certification is desired.
• Three years of physician or medical billing experience involving complex surgical/procedural/multidisciplinary specialties (preferred).

Requirements

• 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.

Benefits

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