Job Profile Summary 

​This role focuses on providing administrative and business support to the organization in order to achieve operational goals.  In addition, this role focuses on performing the following General Administration duties: Produces documents, collects, records, sorts and files information, handles mail, prepares routine reports, makes travel arrangements, arranges appointments, responds to inquiries, data entry, and operates office equipment.   An organizational related support or service (administrative or clerical) role or a role that focuses on support of daily business activities (e.g., technical, clinical, non-clinical) operating in a “hands on” environment.  The majority of time is spent in the delivery of support services or activities, typically under supervision.  An experienced level role that requires basic knowledge of job procedures and tools obtained through work experience and may require vocational or technical education.  Works under moderate supervision, problems are typically of a routine nature, but may at times require interpretation or deviation from standard procedures, and communicates information that requires some explanation or interpretation. 

Job Overview 

This position has collaborative reporting responsibilities to each manager responsible for financial oversight particular to their service line.  Ensures the accuracy of technical billing. Verifies daily and post-discharge charges for billing accuracy, as per each service line’s requirements.  Works closely with the finance office and various insurance agencies to obtain prior authorizations and research claim denials.  Understands the coverage specifics with various insurance agencies and engages physician(s) for additional supportive documentation as requested.   

Job Description 

Minimum Qualifications: 

1. High school diploma or equivalent. 

2. One (1) year of patient registration or insurance experience. 

Preferred Qualifications: 

1. Three (3) years of patient registration or insurance experience. 

2. Healthcare Access Associate (CHAA) Certification. 

3. Experience using computer-based, patient registration systems. 

Duties and Responsibilities: The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list.  Other duties and responsibilities may be assigned. 

1. Performs daily and periodic verification of exported charges for submission accuracy in accordance with specific department requirements using the appropriate programs or software. 

2. Submits charge corrections in a timely manner, in accordance with hospital time constraints. 

3. Verifies patient accounts for valid submission of charges from treatments and visits.   

4. Works closely with the Finance Department and various insurance agencies to ensure all denials and questions on charges are answered within 24 hours. 

5. Obtains appropriate referrals for treatments and visits in a timely manner. 

6. Assists clerical staff with initial and on-going verification of insurance in a timely manner. 

7. Reviews daily schedule to ensure all charges have been captured by the responsible parties by the close of business. 

8. Obtains timely prior authorization of all treatments, studies and medications.   

9. Maintains awareness of coverage specifics pertaining to each insurance company.   

10. Facilitates quality assurance reviews of selected charts for ongoing compliance with various insurance or auditing agencies, as requested.   

11. Engages physician(s) for additional supportive documentation as requested to facilitate authorization. 

12. Assists with compiling various department statistical data. 

Physical Requirements:  

1. Frequent sitting, occasional standing or working, and lifting of 10-15 lbs. 

2. May be exposed to dust and other typical office-like discomforts. 

3. Manual dexterity using fine hand manipulations for computer keyboard operation. 

4. Requires ability to see computer screen and read reports. 

5. Requires ability to hear instructions from physicians and other clinical or nursing staff. 

Skills & Abilities: 

1. Computer literacy including familiarity with word processing programs and electronic spreadsheets. 

2. Strong customer service skills including excellent interpersonal and telephone skills.  

3. High degree of tact is necessary due to frequent interaction with patients, physicians, and insurance companies. 

4. Thorough understanding of private insurance, Medicare, and Medicaid programs. 

5. Knowledge of medical terminology. 

6. Excellent organizational skills required with attention to detail.  

7. Maintains knowledge and awareness of changes to CPT definitions and documentation requirements.   

8. Ability to perform accurate data entry. 

9. Willingness to learn new applications.   

10. Ability to prioritize work and be flexible with work assignments. 

Tufts Medicine is a leading integrated health system bringing together the best of academic and community healthcare to deliver exceptional, connected and accessible care experiences to consumers across Massachusetts. Comprised of Tufts Medical Center, Lowell General Hospital, MelroseWakefield Hospital, Lawrence Memorial Hospital of Medford, Care at Home - an expansive home care network, and large integrated physician network. We are an equal opportunity employer and value diversity and inclusion at Tufts Medicine. Tufts Medicine does not discriminate on the basis of race, color, religion, sex, sexual orientation, age, disability, genetic information, veteran status, national origin, gender identity and/or expression, marital status or any other characteristic protected by federal, state or local law. We will ensure that individuals with disabilities are provided 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. Please contact us to request accommodation by emailing us at careers@tuftsmedicine.org.