Hospital Billing Specialist (Medicare Accounts Receivable)

Hours: 40 hours per week; Monday through Friday - 7:00 AM to 3:30 PM

Location: Onsite training required for first 180 days at 55 Technology Drive - Lowell, MA. Remote flexibility may offered at discretion of the manager after training.

Job Profile Summary

This role focuses on activities related to revenue cycle operations such as billing, collections, and payment processing.  In addition, this role focuses on performing the following Billing related duties: Bills patients for administered care, handles incoming payments, calculates patient intake costs, and tracks accounts receivable to ensure accuracy. Responsibilities also include working with patients to arrange special payment options when necessary.  An organizational related support or service (administrative or clerical) role or a role that focuses on support of daily business activities (e.g., technical, clinical, non-clinical) operating in a “hands on” environment.  The majority of time is spent in the delivery of support services or activities, typically under supervision.  A specialist level role that requires very advanced knowledge of operational procedures and tools obtained through extensive work experience and may require vocational or technical education.  Works under limited supervision for non-routine situations and may be responsible for leading daily operations, and trains, delegates and reviews the work of lower level employees, and problems are typically difficult and non-routine but not complex.

Job Overview

Under general supervision, this position is responsible for accounts receivables, resolution, including but not limited to, eligibility verification, billing edits, claim edits, payer follow-up, correspondence review, corrected claims, appeals, reimbursement verification, and remittance for assigned scope of receivables.

Job Description

Minimum Qualifications:

1. High school diploma or equivalent

2. Two (2) years of experience in a medical billing and collection environment for a medical services provider and/or third-party payor.

Preferred Qualifications:

1. Epic HB Billing, PB Billing or Insurance Follow-Up experience.

2. Completion of a medical terminology course and understanding of CPT and ICD diagnosis coding

3. HFMA CRCR (Certified Revenue Cycle Representative)

4.Epic certifications

Duties and Responsibilities: The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list.  Other duties and responsibilities may be assigned.

1. Performs day-to-day activity to ensure that all information for proper billing is complete and accurate; billing to assigned payers is transmitted or mailed within a timely manner.

2. Conducts follow-up on outstanding account balances with assigned receivables and takes appropriate action for resolution.

3. Responsible for researching and handling rejections, including understanding why a claim rejected, how it must be fixed, and what party is financially responsible. Must initiate any corrective action, including referral to the Team Lead or Supervisor when appropriate.

4. Reviews, evaluates and processes appeals through research and resubmission to appropriate third party with complete and accurate supporting documentation.

5. Responsible for the processing of adjustments due to denials and contractual requirements.

6. Resolves assigned accounts in a timely and accurate manner, maximizing reimbursement in compliance with assigned payer and government regulations, and provider organization and department policies and procedures.

7. Maintains up-to-date knowledge of federal and state regulations and payer requirements along with annual updates to CPT/ICD-10 coding guidelines.

8. Interacts daily over the phone, on the web and through correspondence with payers. Establishes working relationships with payer representatives to facilitate processing of claims.

9. Regular interaction with other departments of the provider organization using electronic system tools to resolve accounts, including Patient Access, Revenue Integrity, Coding, Medical Records, Utilization Review, Hospital Departments, Physician’s Offices, and other administrative teams.

10. Consistently achieves and maintains performance standards for assigned productivity, collections, and quality targets

11. Identifies trends in workflows and rework and reports outstanding operational issues to management for further research and resolution.

Physical Requirements:

1.Work environment: professional office environment with typical office requirements such as computers, phones, photocopiers, filing cabinets, etc.

2. Frequently required to speak, hear, communicate and exchange information

3. Able to see and read computers displays, read fine print, and/or normal type size print and distinguish letters, numbers and symbols

4. Occasionally lift and/or move up to 25 pounds

5.Ability to work in confined or open environments

6.Ability to work independently or in a team environment

Skills & Abilities:

1. Working knowledge of billing requirements for assigned payers and/or service specialties.

2. Ability to systematically analyze problems, draw relevant conclusions and devise appropriate course of action.

3. Ability to analyze data, perform multiple tasks and work independently.

4. Good interpersonal skills in written and verbal form are required.

5. Active communication and participation with email and meetings

6. Technically savvy with use of accounts receivables systems and related applications, email, and spreadsheets.

7. Must be able to develop and maintain professional, service-oriented working relationships with senior leadership, patients, physicians, co-workers and employees.

8. Ability to work in a fast-paced environment, with a focus on team building and productivity.

9. A comprehensive working knowledge of coverage eligibility and the application of Commercial, Blue Cross, Medicare, Medicaid, Managed Care, and other third-party payor rules, regulations, guidelines and requirements for billing, collection and reimbursement. A basic understanding of how these regulations are applied to Massachusetts providers is desirable.

10. Ability to learn PC based computer systems, word processing, database and spreadsheet software programs.

11.Proficient in using computers and navigating through third party application systems and web portals efficiently and effectively.

12 Good interpersonal and communication skills and a basic understanding of team management concepts.

At Tufts Medicine, we want every individual to feel valued for the skills and experience they bring. Our compensation philosophy is designed to offer fair, competitive pay that attracts, retains, and motivates highly talented individuals, while rewarding the important work you do every day.

The base pay ranges reflect the minimum qualifications for the role. Individual offers are determined using a comprehensive approach that considers relevant experience, certifications, education, skills, and internal equity to ensure compensation is fair, consistent, and aligned with our business goals.

Beyond base pay, Tufts Medicine provides a comprehensive Total Rewards package that supports your health, financial security, and career growth—one of the many ways we invest in you so you can thrive both at work and outside of it.

Pay Range:

based on full-time equivalent