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 Billing Specialist role specializes in high dollar claims, aged claims and denied claims for complex specialties. This role identifies and works to resolve denials to uncover root cause and accurately appeal claims to ensure successful initial submission. The Billing Specialist will be responsible for charge and claim review to ensure the correct information is on the claim and it was billed appropriately. The Billing Specialist will work directly with Supervisors and Managers to obtain required information. Additional tasks include researching medical policies, payer billing guidelines, claim requirements, and written letters of medical necessity when required. This role also researches and resolves escalated, disputed self-pay balances. The Billing Specialist will educate Supervisors & Managers on workflows to help optimize denial processing and prevent future denials.
Essential Duties & Responsibilities including but not limited to:
- Responsible to work and resolve all back end high dollar, complex, and aged 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 physicians 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 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.
- 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.
- Demonstrates 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: Associate's degree or equivalent experience.
Licensure, Certification & Registration: Billing Certification Preferred - Epic Resolute Professional/Hospital Billing Admin (Proficiency, Proficiency w/Honors, or Certification)
Experience: 3 years of experience in denial management environment 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 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.