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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. green decorative barWith 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.

PFS Revenue Billing Spec

Job ID 145418 Date posted 10/31/2017


Position Summary:
The PFS Medical Billing Specialist role specializes in registration related issues and is vital to ensure that accounts related to registration issues are thoroughly reviewed for any opportunity to bill insurance, correct errors, re-file and or appeal for corrected processing and reimbursement of physician charges. The role also includes review and analysis of registration related issues and errors as well as education to reduce errors and denials and increase professional revenue.

Essential Duties & Responsibilities including but not limited to:
1. Responsible to work and resolve all back end registration related workqueues. Reviews and completes continuous daily work queue volume for registration related denials.
2. Responsible to work and respond to all customer service inquiries in regards to registration related patient accounts.
3. Responsible to work claim rejections due to registration related issues returned by the payor preventing claims submission.
4. Makes necessary updates to the Epic patient registration and initiates rebilling, correcting billing or denials explanation back to customer service.
5. Researches systems for active insurance coverages for self pay balances beyond set thresholds to prevent missed cash collection opportunity.
6. Works with department throughout the organization, third party vendors and insurance carriers to resolve issues related to registration and customer inquiries.
7. Works with Hospital, Professional and Home Health Billing Teams when identifying trends that can lead to inappropriate billing to the customer.
8. Working in a SBO (Single Billing Office), environment the Medical Billing Specialist will need to have knowledge in Hospital and Professional Billing in order to assist with customer on questions and accurate registration of insurance.
9. Proactively identifies problems and opportunity for improvements related to system usage, training and end user education, practice and user trends and makes recommendations to the Manager of Revenue System Operations and partners with the Manager of Epic Training and/or the perspective departments with high volume/high dollar value for resolution.
10. Assists in the development of reporting mechanisms to identify trends and track so that education can be performed to reduce and/or resolve high dollar/high volume values.
11. Completes all assignments per the turnaround standards. Reports unfinished assignments to the Manager or Revenue Support
12. Attends meetings and serves on committees as requested.
13. Achieves exemplary audit results and consistently exceeds productivity standards.
14. Provides and promotes ideas geared toward process improvements within the Central Billing Office.
15. Independently works on the resolution of complex claims issues, denials and appeals.
16. Completes projects and research as assigned.
17. Responsible for the mentoring and training of new and end existing A/R staff as it related to registration following the training program set forth to include but not limited to policy and procedures, Epic system functionality, audits and staff reviews

Secondary Functions:
18. Enhances professional growth and development through in-service meetings, education programs, conferences, etc.
19. Complies with policies and procedures as they relate to the job.
20. 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.
21. Refers complex or sensitive issues to the attention of the Manager of Revenue System Operations to ensure corrective measures are taken in a timely fashion.
22. Accepts and learns new tasks as required and demonstrates a willingness to work where needed.
23. Assists other staff as required in the completion of daily tasks or special projects to support the department?s efficiency.
24. Performs similar or related duties as assigned or directed.

Organizational Requirements:
Maintain strict adherence to the Lahey Hospital and Medical Center Confidentiality policy.
Incorporate Lahey Hospital and Medical Center Standards of Behavior and Guiding Principles into daily activities
Comply with all Lahey Hospital and Medical Center Policies.
Comply with behavioral expectations of the department and Lahey Hospital and Medical Center.
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.

Minimum Qualifications:
Education: High School Diploma required, bachelor?s degree preferred

Licensure, Certification & Registration: Billing Certification Preferred

Experience: 5 years of experience in registration billing and denial management environment related field or front end access related field. Experience in training and staff development

Skills, Knowledge & Abilities: Strong knowledge of third party payor reimbursement, eligibility verification process and government and payor compliance rules.

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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