Patient Financial Services - Mass Health Follow-Up Rep II

Job Details

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Job ID:
25787

Location:
10 Brookline Place West, Brookline, MA 02445

Category:
Finance/Accounting

Employment Type:
Full time

Work Location:
Full Remote: 4-5 days remote/wk

Overview

Located in Boston and the surrounding communities, Dana-Farber Cancer Institute is a leader in life changing breakthroughs in cancer research and patient care. We are united in our mission of conquering cancer, HIV/AIDS and related diseases. We strive to create an inclusive, diverse, and equitable environment where we provide compassionate and comprehensive care to patients of all backgrounds, and design programs to promote public health particularly among high-risk and underserved populations. We conduct groundbreaking research that advances treatment, we educate tomorrow's physician/researchers, and we work with amazing partners, including other Harvard Medical School-affiliated hospitals.

The primary function of the P/A Biller Specialist is the daily management of an assigned portion of the accounts receivable, typically allocated based on payer and alphabetical splits. Basic responsibilities include regular and consistent billing or follow-up work on outstanding third-party claims, denial management, verification of accurate reimbursement, and correction and/or reprocessing of claims as necessary. The Billing Specialist should remain in full compliance with all departmental, institutional and regulatory policies and procedures. Confidentiality is a key function of this role. The Specialists will have regular exposure to patient demographics, diagnostic and billing information. Additionally, they will have exposure to physician information including physician numbers assigned by governmental agencies and insurance carriers. The Specialists may also perform other duties as assigned, including but not limited to, special patient accounting projects, charge entry, and cash applications.

 

Requirements

  • Serves as a team leader and go-to resource for staff questions.
  • Acts as a point of contact for management and resource for special projects.
  • Manages assigned payer’s issues and assists with provider meeting preparation.
  • Keeps supervisor informed of changes to billing regulations for government and third-party payers.
  • Utilizes knowledge to update billing requirements, edit policies and formulate new processes.
  • Performs analysis of identified issues and presents management with potential solutions.
  • Assists supervisors with coaching and training of billing specialists as needed.
  • Always presents him/herself in a professional manner.
  • Daily management of the assigned portion of the accounts receivable including: 
    • Reviewing claim denials and working with internal departments to provide information necessary to have the claim adjudicated by third-party payers.
    • Managing follow up efforts with third-party payers via websites, intermediaries, mail, email, fax and phone.
    • Comparing payments on open A/R accounts to the related payer contracts to ensure proper payment and adjustment amounts have been posted.
    • Maintaining open credit balances to ensure proper adjustments have been made or processes third-party refunds when necessary.
    • Fulfills documentation requests from payers, specifically medical records, claims, itemized bills, Letters of Agreements, proof of timely filing, appeals and other requests as needed.
  • Ability to operate out of multiple systems as assigned. (ie claim scrubber, billing system, email, payer portals).
  • Willingness to identify and escalate issues and trends to management.
  • Flexibility to work on ad-hoc projects that serve the team, while maintaining assigned portion of the A/R.
  • Open to learning new workflows and processes while providing constructive feedback based on past experiences and forward-thinking ideas.
  • Acquire and maintain working knowledge of payer policies, behaviors and updates as assigned.

Qualifications

  • Bachelor’s degree preferred or a minimum of 5 years of experience required.

  • General experience within an office setting and computer skills preferred. 

  • Performs primary duties above as directed and requires moderate supervision.

  • Experience working with various software applications, including Microsoft Office and various billing software preferred.

  • Experience with patient account applications and procedures preferred.

KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED:

The Biller Specialists should have knowledge of third party billing regulations, as well as of hospital and/or professional operations, and third party payer requirements.  The Biller Specialists should have working knowledge if industry standard medical coding conventions. They should be dependable, self-starters and be deadline driven.  In addition to the previously mentioned, have strong oral and written communication skills and have the ability to work well independently as well as in a team setting.




Dana-Farber Cancer Institute is an equal opportunity employer and affirms the right of every qualified applicant to receive consideration for employment without regard to race, color, religion, sex, gender identity or expression, national origin, sexual orientation, genetic information, disability, age, ancestry, military service, protected veteran status, or other groups as protected by law.

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