BILLING REPRESENTATIVE IIDescription:
General Overview
Reporting directly to the Orthopaedic Billing Director, the Senior Billing Specialist performs a variety of billing functions to minimize accounts receivable and enhance collection performance. This position requires work on all activities within the billing and reimbursement team, with little or no direct supervision. It further requires the use of electronic billing, medical record retrieval, and scanning systems; as well as in depth knowledge of medical billing and insurance rules and regulations to resolve accounts receivable issues. This role may require assisting the Reimbursement Director with projects and other duties as assigned.
Responsibilities
1) Perform all aspects of the Senior Billing Representatives position with a high and consistent degree of proficiency.
2) Work very sensitive / high dollar / complex receivables via IDX PCS & IDX TES workfiles.
3) Oversee A/R projects and provide immediate feedback to the Director of Reimbursement.
4) Identify trends, patterns, changes, and errors affecting the billing and collection of Orthopaedic receivables; and communicate these issues in a summary fashion, inclusive of proposed solutions, to Senior Management.
5) Utilize insurance rules and regulations knowledge to interpret new insurance/HCFA/HIPPA information and report potential affect on billing and collection process.
6) Request necessary data to resolve issue and trends once identified within their workfiles and follow through on resolutions to completion.
7) Utilize experience and expertise to efficiently and effectively determine the correct course of action on each account, project, and/or assignment.
8) Represent the department, as required, in meetings with other MGH/MGPO staff and/or with Insurance/Provider Relation Representatives; and provide feedback regarding meetings to other team member and/or senior management within MGOA.
9) Act as a resource for Junior Billing Specialists with respect to coaching, training, and mentoring.
10) Compile/Request data to complete special billing projects based on contractual obligations and regulatory demands.
11) Conduct intense and tenacious follow-up on multi-million dollars receivables.
12) Meet deadlines and daily productivity standards for IDX/PCS workfiles, including but not limited to:
Verifying insurance
Referral/denial Management
Correspondence & phone inquiries
Billing/mailing claims with attachments; such as EOBs, Medical Records, and/or Physician Letters
Working claim edits & scrubbers
Third party follow-up including secondary billing & rejections
Special projects as assigned
Skills/Abilities/Competencies
Ability to manage multiple tasks/projects simultaneously
Demonstrated PC and electronic data processing skills; including but not limited to EDI verification of insurance coverage, Microsoft Word, Excel, Outlook email, Partners voice-mail system, Scanning, and Payer Websites
Participate in continuous quality improvement efforts on an ongoing basis
Establish goals and track progress in concert with the Director of Reimbursement
Comply with hospital confidentiality policy; as well as HIPAA/PHI requirements
Manage special projects and other duties as assigned.
Qualifications
Associates degree or equivalent preferred. A minimum of five years experience in a high volume medical billing and collection environment.
IDXBAR, IDXPCS, IDXTES, and PATCOM proficiency highly preferred
Effective communication, organizational, and problem solving skills
Detailed working knowledge of medical terminology, ICD-9 coding, CPT, and HCPCS
Working Environment
Office environment. 8-5PM. 40 Standard Hours
Qualifications:
Company Profile:
Founded in 1811, Massachusetts General Hospital is the third-oldest general hospital in the country, and the oldest and largest in New England. The 907-bed world-renowned medical center offers sophisticated diagnostic and therapeutic care in virtually every specialty and subspecialty of medicine and surgery. The largest teaching hospital of Harvard Medical School, MGH is on the cutting edge of patient care, research and medical education. It is the largest nongovernment employer in the city of Boston, with more than 21,500 employees.
MGH is among the leading medical institutions continuously recognized by U.S. News & World Report's annual honor roll of America's best hospitals. In 2009, MGH ranked fifth nationally, with MGH Psychiatry ranking first in that specialty for the 14th consecutive year. MGH has been named to the list since the publication began conducting the survey in 1990.
In 2008, MGH again was named a Magnet hospital by the American Nurses Credentialing Center, a subsidiary of the American Nurses Association. The Magnet Recognition Program recognizes health care organizations that provide the best in nursing care and to uphold the tradition of excellence in professional nursing practice. MGH was the first Massachusetts hospital to earn the Magnet designation in 2003.
MGH has repeatedly been named an employer of choice. Most recently, it was named to The Globe 100, a list of the top employers in Massachusetts compiled by The Boston Globe. The hospital has also earned a spot on Conceive magazine's 2009 list of the Top 50 Workplaces for Prospective Parents.
A career with MGH means you'll be part of a rich legacy of providing top-quality patient care and an integral part of ensuring that our success continues. Located in Boston, MGH is accessible by several MBTA lines. Our benefits and perks are outstanding and include health/dental insurance, a retirement plan, 403b, paid time off, tuition reimbursement, childcare center and a fitness center. There is only one MGH! For more information, please visit us at .
Massachusetts General Hospital is an Equal Employment/Affirmative Action Employer.
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