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Pt Access HB PB Billing Spec, 40 hours

Job ID 149301 Date posted 07/21/2018

Beverly Hospital, A member of Lahey Health, promotes the culture and philosophy which enables employees to give and receive the best of care. You can become a part of the team that achieves this success through our CREATE values of Compassion, Respect, Excellence, Accountability, Teamwork, and Empathy.

Ensures that all proper patient financial and demographic information is obtained and processed so Northeast Hospitals is fully reimbursed for clinical services provided. Performs follow up on inpatient and observation admissions by re-verifying insurance eligibility and benefits, when the need arises. Works on all workqueues that would adversely affect the claim being paid immediately. When working the workqueues, is able to track errors being made by certain individuals and will report back to the respective Patient Access Manager of any trends that they may see with regards to errors being made or fields being left unfilled by certain staff members. Works on the Account WQs: replying to Coding regarding the information Coding needs to complete coding the claim; adjusting the coverages and making sure that the correct coverages have been placed on the claim and the coverages are listed in the correct order; ensuring the valid Guarantor has been listed on the claim; for all claims missing a provider, will enter the correct provider in the attending, PCP, and referring physician fields and then into the same fields in Coding; will work all of the hospital accounts off of the ?primary Contact? WQ, by researching first and then either checking the patient in or cancelling or rescheduling the patient (but by the end of each day this WQ should be at zero); verifying the Hospice patients hospital accounts to make sure that the account has been flagged, Hospice entered as the primary payor, Medicare listed as the secondary payor, etc. and then completing this off the WQ so that the claim can be paid without any problem; obtains authorizations and referrals for any hospital account hitting the WQ stating that an authorization or referral is missing, noting in the account the authorization or referral when it is obtained and forwarding the account to Hospital Billing in Patient Financial Services for the bill to drop; and filing appeals for any denials that the insurance companies have denied payment for by doing extensive research and putting together all of the paperwork required to get the denial overturned. Works on the Professional Billing WQs: for all medical inpatients that have a behavioral health consult, the account must be flagged as ?Behavioral Health Payor? and a Behavioral Health Guarantor needs to be added to the account; corrects other professional billing claim information that pops up on the WQ, such as subscriber identification number, matching the subscriber name to the patient name when subscriber is self, making sure the services dates are within the coverage dates, etc.; and obtains professional authorizations and referrals for any account hitting the WQ stating that an authorization or referral is missing, noting in the account the authorization or referral when it is obtained, and finally forwarding the account to Professional Billing in Patient Financial Services (PFS) for the bill to drop. Works on the Hospital Billing WQs: makes sure the subscriber identification number is correct; researching missing items and entering them in for all motor vehicle (MVA) and third party liability (TPL) claims; if the Medicare Secondary Payor Questionnaire (MSPQ) has not been completely filled out, enter the correct information and the claim will be able to drop; making sure the service dates on the claim are within the effective dates of the insurance in the account; verifying if the patient?s consent for treatment is on file and correcting this immediately; verifying the point of origin for claims that hit this WQ due to this reason by researching the claim; and correcting any other Code 100 workrules that pop into this WQ. Works the Router Review WQs: fixing the professional billing accounts that are popping in this WQ due to an error made in the Guarantor field; and assigning Hospital Account Records (HARs) to accounts in this WQ in which charges have been placed on patients and their medical record numbers by a particular department for a date of service however there was never an account for these departments to place the charge on or the department did not look for an account (HAR) and put the charge just on the patient and their medical record number. This position will be based in Patient Access Services and have close connections with both the Hospital and Professional Billing staff located in Patient Financial Services in Burlington.


High School, Bachelor?s degree preferred.

5 years experience in Patient Access Services or Professional Billing or Hospital Billing required. Prior experience in a healthcare business setting processing and verifying electronic demographic, financial or other business-related information and data. Healthcare experience within registration or financial services (hospital billing or professional billing) required. Epic experience preferred.

Able to work successfully in a fast-paced, multi-task environment, where independent decision making is necessary. Able to process electronic information and data accurately and efficiently.

Scheduled Hours

40 hours per week, Monday through Friday