Hours: 40 hours per week; Monday through Friday from 7-3:30 PM or 7:30-4 PM
Location: 100% onsite at 100 Potash Hill Rd Suite 150 - Tyngsborough, MA
Job Profile Summary
This role focuses on activities related to revenue cycle operations such as billing, collections, and payment processing. In addition, this role focuses on performing the following Patient Financial Services duties: Facilitates the reimbursement for clinical services provided to patients. Submits claims to health insurers, follows up with health insurers about submitted claims, and performs appeals for non-clinical denials, etc. 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. A senior level role that requires broad knowledge of operational procedures and tools obtained through extensive work experience and may require vocational or technical education. Works under limited supervision for routine situations, provides assistance and training to lower level employees, and problems typically are not routine and require analysis to understand.
Job Overview
This position performs services in the billing section of the Patient Accounting area according to the policies, procedures, philosophy, and objectives of the department and hospital. Works cooperatively within department and other services to create a system of quality health care.
Job Description
Minimum Qualifications:
1. High school diploma or equivalent.
2. Two (2) years of related experience.
Preferred Qualifications:
1. Associate’s degree.
2. Five (5) years of experience in a medical billing and collection environment for a medical services provider and/or third-party payor.
3. Completion of a medical terminology course.
4. Completion of medical coding certificate program.
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 day-to-day activities to ensure that all information for proper billing is complete and accurate; billing to assigned payers is transmitted or mailed within a timely manner.
2. Works with billing staff to resolve billing and collections issues.
3. Conducts follow-up of outstanding account balances with assigned payers and takes action for resolution.
4. Reviews, evaluates and processes all disputes and appeals through research and resubmission to appropriate third party of complete and accurate supporting documentation.
5. Recommends/performs third party adjustments and write-offs to Team Leader or Supervisor.
6. Responsible for researching and handling all rejections, including understanding why a claim rejected, how it must be fixed, whether the patient is now liable or whether the hospital is liable. Must initiate any corrective action, including referral to the supervisor when appropriate.
7. Ensures correspondence is identified, routed and worked accurately, completely and timely.
8. Counsels with patients and family members of patients on some of the more complicated and/or sensitive situations related to billing and collections.
9. Performs reviews of accounts that may be appropriate for closure due to Bankruptcy or Deceased No Estate, ensuring that the applicable process and procedures are consistently followed.
10. Assists with the review of contractual adjustments and write-offs associated with self pay accounts. Ensures that any write-offs are properly categorized and recorded into the correct classification of bad debt or charity care.
11. Processes adjustments due to denials, contractual requirements, and credit balances.
12. Processes special projects for batch billing, follow-up, and claims adjudication.
13. Resolves assigned accounts in a timely and accurate manner, which maximizes reimbursement in compliance with assigned payer regulations and department’s policy and procedure.
14. Facilitates regular interactions with other departments of the hospital using electronic system tools to resolve accounts, including.
15. Interacts on a daily basis over the phone and through correspondence with assigned payers. Establishes working relationships with payer representatives to facilitate payment processing.
16. Consistently achieves and maintains performance standards for assigned productivity, collections, and quality targets.
17. Identifies trends in workflows and rework, and report outstanding operational issues to management for further research and resolution.
Physical Requirements:
1. Professional office environment with typical office requirements such as computers, phones, photocopiers, filing cabinets, etc.
2. Frequent sitting with periods of prolonged standing/walking while pushing a computer on wheels while registering patients at the bedside.
3. Frequently required to speak, hear, communicate and exchange information.
4. Able to see and read computers displays, read fine print, and/or normal type size print and distinguish letters, numbers and symbols.
5. Occasionally lift and/or move up to 25 pounds.
6. Ability to work in confined or open environments.
7. Requires manual dexterity using fine hand manipulation to operate computer keyboard.
8. Ability to hear patient responses.
Skills & Abilities:
1.Ability to work independently or in a team environment.
2. Maintains knowledge of CPT/ICD-10 coding guidelines.
3. A comprehensive working knowledge of the application of Commercial, Workers Compensation and other third-party payor rules, regulations, guidelines and requirements for billing, collection and reimbursement appeals.
4. Technical Savvy with utilizing billing and accounts receivable software and related applications, email, and spreadsheets.
5. Good interpersonal and communication skills and a basic understanding of team management concepts.
6. Ability to systematically analyze problems, draw relevant conclusions and devise appropriate course of action.
7. Excellent workflow and analytical thinking skills.
8. Ability to effectively present complex issues to internal and external customers.
9. Active communication and participation with email and meetings.
10. Good interpersonal skills in written and verbal form are required.
11. Ability to develop and maintain professional, service-oriented working relationships with senior leadership, patients, physicians, co-workers and employees.
12. Ability to work in a fast-paced environment, with focus on team building and productivity.
13. Ability to effectively manage complex issues simultaneously.
14. Ability to prioritize and respond effectively to multiple and /or changing job expectations.
15. Capability of working independently and completing the range of daily tasks in a timely and efficient manner and at a high level of quality.
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.