Location: Burlington, MA
Job ID: 169006-1A
Date Posted: Jul 7, 2021
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
Responsible for clean and timely submissions of 837I and UB claims to insurance carriers to ensure maximum reimbursement for the Hospital Health System.
Essential Duties & Responsibilities including but not limited to:
1) Responsible for the timely submission of clean 837I and/or UB claims.
2) Follows up on 277CA rejections within assigned WQ’s until acceptance validation has been received by the payer.
3) Interacts by telephone and/or mail with payers relative to claims processing.
4) Resubmits claims when necessary, utilizing a variety of EDI technologies and relevant billing systems to reduce aged rejections.
5) Reviews, validates, and updates coverage changes on hospital accounts within assigned WQ to avoid denials (i.e. COB, invalid payer, etc)
6) Resolves accounts within Hospital Billing Claim Edit WQ’s due to invalid account information(i.e., wrong subscriber ID format, patient demographics, etc)
7) Sorts, prepares and processes incoming and outgoing paper UB and insurance correspondence.
8) Maintains detailed documentation on individual account activity such as correspondence, phone conversations, and the like.
9) Resolves specific payer/plan claim edits in assigned WQ’s generated from within Epic and the external Clearinghouse Vendor.
10) Establishes relationships and maintains open communication with third party payor representatives in order to resolve claims issues.
11) Identifies internal and/or external billing issues and notifies Supervisor and/or Manager.
12) Alerts Supervisor and/or Manager to procedural and/or system changes based upon payer billing requirements
13) Accessing payer websites for eligibility, claim status, possible online corrections, and viewing both the most current EDI and paper billing regulations.
Education: High School Diploma or equivalent.
Licensure, Certification & Registration: n/a
Experience: Minimum 1 year experience in hospital billing and/or related activities.
Skills, Knowledge & Abilities: n/a
Beth Israel Lahey Health is dedicated to improving health and wellness and making a difference in the lives of our patients, their families and all members of the communities we serve. Formed in March 2019, Beth Israel Lahey Health is a patient-centered, integrated care delivery system providing a continuum of services spanning academic, tertiary and community hospitals, dedicated orthopedic and psychiatric hospitals, primary and specialty care, community acute care, ambulatory care, behavioral services and home health. Beth Israel Lahey Health Performance Network is a unified joint contracting and population health management organization, jointly governed by participating physicians and hospitals.
Equal Opportunity Employer/Minorities/Females/Disabled/Veterans.