Job Details

Overview

Patient Financial Services Specialist (Hospital Billing) Remote Beth Israel Lahey Health. This position operates in a fully remote capacity. Under oversight of the Department Manager & Supervisor, the Patient Financial Services Specialist Hospital Billing is responsible for efficient and timely billing and collections of hospital outstanding balances on inpatient and outpatient accounts receivable of higher complexity within assigned work queues for a large multi-facility healthcare system with future expansion anticipated to maximize reimbursement to the health system.

Essential Responsibilities

• Utilizes the Epic Hospital Billing System to review and monitor accounts through the Billing, Denial, & Follow-Up work queues.
• Works assigned accounts with higher complexity (high dollars, specific denial records, etc.) within Hospital Billing, Denial, & Follow-Up work queues while maintaining established productivity requirements.
• Contacts insurance carriers or other responsible parties to confirm payment dates, ask why a claim was denied, or questions why a claim was not processed for payment or denial.
• Performs all Hospital Billing, Follow-Up, and Denial activities necessary to obtain payment/resolution of claims.
• Reviews the entire account to ensure claims were billed properly, payments were applied correctly, and all necessary adjustments were made before moving to the next responsible party and/or adjusting balances and removing them from work queues.
• Gathers all necessary documentation needed to have claims reprocessed/adjudicated.
• Informs and/or transfers to management any problem accounts and/or denial trends that require escalation within 2 days of identification.
• Documents all actions taken within the EPIC account notes section and/or follow-up/denial activities note sections. Adheres to departmental policies and procedures/training documents.
• Completes necessary training sessions required for the Hospital Billing system and demonstrates working knowledge to successfully resolve assigned accounts within Follow-Up and Denial work queues.
• Documents inactive periods and makes them available upon management's request.
• Resolves accounts with higher complexity in any Claims Edit work queue and resubmits claims through the Epic Billing System.
• Works higher level of complexity in specific claim edit work queue(s) daily and resubmits claims through the Epic Billing System.
• Works higher level of complexity external claim edits from clearinghouse and resubmits claims through the Epic Billing System.
• Handles paper claims processing including proper documentation of accounts with higher level of complexity.
• Communicates all claims/data problems that cannot be handled to the Supervisor/Manager within one (1) day of identifying the problem.
• Identifies and researches incomplete or inaccurate information on claims, demonstrates proper handling and escalation as needed.
• Handles payer 277 rejections on accounts with higher level of complexity and resubmits claims through Epic Billing System or other submission means; provides trends to management for payer outreach and/or internal system updates to ensure timely filing and reimbursement.

Skills, Knowledge & Abilities

• Demonstrates excellent attention to detail and prioritization of accounts.
• Demonstrates strong working knowledge of Epic Hospital Billing Follow-Up and Denial workflows; SME to team and colleagues.
• Demonstrates clear oral and written communication.
• Demonstrates professional telephone & email etiquette.
• Interacts professionally with insurance carriers, patients, and co-workers.
• Strong billing computer and PC skills.
• Strong problem solving and decision-making skills.
• Ability to resolve account issues to completion and obtain appropriate payment.
• Ability to work independently and efficiently.

Qualifications

• Preferred Qualifications & Skills: Experience in Revenue Cycle Accounts Receivable; Experience working with EPIC.
• Experience: At least five (5) years accounts receivable experience required.
• Education: High School Diploma / GED Required.

Pay and Benefits

Pay Range: $0.00 - $114,712.00. The pay range listed is the base hourly wage range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is based on factors such as seniority, education, training, relevant experience, certifications, geography, job responsibilities, and applicable laws. Compensation may exceed base rate due to shift differentials, call pay, premium pay, overtime, and other pay practices as applicable.

As a healthcare organization, Beth Israel Lahey Health requires that all staff be vaccinated against influenza as a condition of employment.

Equal Opportunity Employer/Veterans/Disabled

Additional Information

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