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As a health care organization, Lahey Hospital and Medical Center is committed to providing high quality, safe patient care. As an employer, Lahey is committed to ensuring a professional environment where every staff member is encouraged to excel. With a team approach to care, physicians and nurses at Lahey work side-by-side with allied health professionals, medical technologists, and administrative and support staff to deliver on our mission. Lahey encourages learning and growth at all levels, and we offer competitive salaries and benefits.
Medical BillerApply Now Job ID 144771 Date posted 11/14/2017
Identifies, reviews, and interprets third party payments, adjustments and denials. Initiates corrected claims, appeals and analyzes unresolved third party and self-pay accounts, initiating contacts and negotiating appropriate resolution (internal and external) to ensure timely and maximum payment. Works directly with the Billing Supervisor to resolve complex issues and denials through independent research and assigned projects.
Essential Duties & Responsibilities including but not limited to:
1. Monitors days in A/R and ensures that they are maintained at the levels expected by management. Analyzes work queues and other system reports and identifies denial/non-payment trends and reports them to the Billing Supervisor.
2. Responds to incoming insurance/office calls with professionalism and helps to resolve callers? issues, retrieving critical information that impacts the resolution of current or potential future claims.
3. Establishes relationships and maintains open communication with third party payor representatives in order to resolve claims issues.
4. Reviews claim forms for the accuracy of procedures, diagnoses, demographic and insurance information, as well as all other fields on the CMS 1500.
5. Reviews and corrects all claims/charge denials and edits that are communicated via Epic, Explanation of Benefits (EOB), direct correspondence from the insurance carrier or others and uses information learned to educate PFS and office staff to reduce future denials and edits of the same nature. Initiates claim rebilling or corrections and obtains and submits information necessary to ensure account resolution/payment
6. Identifies invalid account information (i.e.: coverage, demographics, etc.) and resolves issues.
7. Evaluates delinquent third party accounts and processes based on established protocols for review, payment plan or write-off.
8. Reviews/updates all accounts for write-offs and refunds.
9. Completes all payment posting assignments per the turnaround standards. Reports unfinished assignments to the Billing Supervisor.
10. Keeps informed of all federal, state, and managed care contract regulations, maintains working knowledge of billing mechanics in order to properly ascertain patients? portion due.
11. Completes all assignments per the turnaround standards. Reports unfinished assignments to the Billing Supervisor.
12. Handles incoming department mail as assigned.
13. Attends meetings and serves on committees as requested.
14. Maintains appropriate audit results or achieves exemplary audit results. Meet productivity standards or consistently exceeds productivity standards.
15. Provides and promotes ideas geared toward process improvements within the Central Billing Office.
16. Assists the Billing Supervisor with the resolution of complex claims issues, denials and appeals.
17. Completes projects and research as assigned.
1. Enhances professional growth and development through in-service meetings, education programs, conferences, etc.
2. Complies with policies and procedures as they relate to the job. Ensures confidentiality of patient, budget, legal and company matters.
3. Exercises care in the operation and use of equipment and reference materials. Performs routine cleaning and preventive maintenance to ensure continued functioning of equipment. Maintains work area in a clean and organized manner.
4. Refers complex or sensitive issues to the attention of the Billing Supervisor to ensure corrective measures are taken in a timely fashion.
5. Observes irregularities in the cash/denial posting process and reports them immediately to the Billing Supervisor.
6. Accepts and learns new tasks as required and demonstrates a willingness to work where needed.
7. Assists other staff as required in the completion of daily tasks or special projects to support the department?s efficiency.
8. Performs similar or related duties as assigned or directed.
Maintain strict adherence to the Lahey Health Confidentiality policy.
Incorporate Lahey Health Standards of Behavior and Guiding Principles into daily activities.
Comply with all Lahey Health Policies.
Comply with behavioral expectations of the department and Lahey Health.
Maintain courteous and effective interactions with colleagues and patients.
Demonstrate an understanding of the job description, performance expectations, and competency assessment.
Demonstrate a commitment toward meeting and exceeding the needs of our customers and consistently adheres to Customer Service standards.
Participate in departmental and/or interdepartmental quality improvement activities.
Participate in and successfully completes Mandatory Education.
Perform all other duties as needed or directed to meet the needs of the department.
Education: High School diploma or equivalent
Licensure, Certification & Registration: Billing Certification,
Experience: 1-2 years of experience in billing, coding, denial management environment related field.
Skills, Knowledge & Abilities:
Ability to work independently and take initiative
Good judgment and problem solving skills
Excellent organizational skills
Ability to interact and collaborate effectively and tactfully with staff, peers and management.
Ability to promote team work through support and communication.
Ability to accept constructive feedback and initiate appropriate actions to correct situations.
Ability to work with frequent interruptions and respond appropriately to unexpected situations.
About Lahey Health
At Lahey Hospital & Medical Center, as one of the world's premier health care organizations, we provide superior health care leading to the best possible outcome for every patient. We exceed our patients' high expectations for service each day. We also help advance medicine through research and the education of tomorrow's health care leaders
We care for our patients with compassion and openness, unsurpassed expertise, a drive for continuous learning improvement, and with respect, caring, teamwork, excellence and commitment to doing our personal best.
Join our team and our mission of excellence by applying today!
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