Welcome to Shared Services, our team uses a coordinated approach to delivering administrative and operational services across Lahey. Our Shared Services colleagues leverage resources across the organization to ensure we provide high-quality, high-value care to the communities we proudly serve. The Shared Services team includes colleagues who focus on business and network development, legal services, facilities and real estate, human resources, information technology, finance, philanthropy and marketing and communications.
About the Job
The PFS Medical Billing Specialist role specializes in complex denials/specific issues and is vital to ensure that accounts 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 physician billing 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:
- Responsible to work and resolve all back end physician billing denials as assigned. Reviews and completes continuous daily work queue volume for related denials.
- Responsible to work and respond to all customer service inquiries in regards to physician billing related patient accounts as assigned.
- Responsible to work claim rejections due to physician billing related issues returned by the payor preventing claims submission.
- Makes necessary updates to the Epic patient registration and initiates rebilling, correcting billing or denials explanation back to customer service as assigned.
- Researches systems for active insurance coverages for self pay balances beyond set thresholds to prevent missed cash collection opportunity.
- Works with department throughout the organization, third party vendors and insurance carriers to resolve issues related to physician billing and customer inquiries.
- Works with Hospital, Professional and Home Health Billing Teams when identifying trends that can lead to inappropriate billing to the customer.
- 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 and or processing physician billing denials.
- 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.
- 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.
- Completes all assignments per the turnaround standards. Reports unfinished assignments to the Manager or Revenue Support
- Attends meetings and serves on committees as requested.
- Achieves exemplary audit results and consistently exceeds productivity standards.
- Provides and promotes ideas geared toward process improvements within the Central Billing Office.
- Independently works on the resolution of complex claims issues, denials and appeals.
- Completes projects and research as assigned.
- Provides support for the mentoring and training of new and end existing A/R staff as required following the training program set forth to include but not limited to policy and procedures, Epic system functionality, audits and staff reviews
- Enhances professional growth and development through in-service meetings, education programs, conferences, etc.
- Complies with policies and procedures as they relate to the job.
- 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.
- 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.
- Accepts and learns new tasks as required and demonstrates a willingness to work where needed.
- Assists other staff as required in the completion of daily tasks or special projects to support the department’s efficiency.
- Performs similar or related duties as assigned or directed.
- High School Diploma required, bachelor’s degree preferred
Licensure, Certification & Registration:
- Billing Certification Preferred
- 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.
Beth Israel Lahey Health is comprised of world-class academic medical centers and teaching hospitals, leading community hospitals, a renowned orthopedics hospital, and comprehensive ambulatory centers. Through our focus on population health, our clinically integrated network of affiliated providers, as well as vital services such as behavioral health and home care services, we are able to provide a new model of care that improves the health of all those we serve. With more than 9,000 nurses, 4,300 physicians and more than 35,000 employees, our model ensures care is highly coordinated and locally delivered, with lower costs and exceptional quality.
Beth Israel Lahey Health is committed to attracting, developing and retaining top talent in a market long recognized and revered as a global leader in health. With a team approach to care, we encourage learning and growth at all levels, and we offer competitive salaries and benefits. We adhere to the principles of a just and fair work environment for all colleagues, where respect is foundational. We strive to create a diverse and inclusive workplace that reflects the communities in which we work and serve.