POSITION SUMMARY:
Under supervision of a Senior Manager of Vendor Management, the Revenue Cycle Business Partner I plays a crucial role in supporting revenue operations within the organization. This position involves a combination of administrative and analytical tasks to ensure accurate billing, timely reimbursement, and compliance with regulatory requirements for Hospital and Professional claims. This includes claim correction, submission, and billing up activities, including interacting with insurance payers and third party vendors to resolve claim adjudication issues. This position will be responsible for working billing tasks of moderate complexity, including billing activities requiring insight in to claim processes and follow up activities requiring understandings of payer contracts. The individual will serve as a knowledge resource to other staff within the Revenue Cycle Department. This role requires adherence to quality assurance guidelines as well as established productivity standards to support the work unit’s performance expectations and to ensure the accurate and timely submission and subsequent payment of all claims.
Position: Revenue Cycle Business Partner I
Department: PFS Administration
Schedule: Full Time, Quincy MA
ESSENTIAL RESPONSIBILITIES / DUTIES:
- Compile, analyze, and interpret revenue cycle data to identify trends, patterns, and opportunities for process improvement.
- Generate regular reports and dashboards to track key performance indicators (KPIs) related to billing, collections, and reimbursement.
- Provide insights and recommendations based on data analysis to optimize revenue cycle performance and efficiency
- Review and collaborate with vendors to handle late charges, including submitting late charge claims or late replacement claims with the appropriate Type of Bill (TOB)
- Participate in internal audits and quality assurance activities to maintain compliance and integrity of revenue cycle processes
- Reviews, reconciles, and makes necessary corrections to edits received from BMC’s clearinghouse. Some focus will be dedicated to complex accounts or payers
- Proactively and professionally contacts insurance companies, government agencies, patients, and other customers via phone, email, or paper correspondences to gather or provide information required for the successful submission and resubmission of claims.
- Utilizes full range of information and tools available on insurance and third party websites to gather required information
- Interacts professionally with customers to answer billing and payment questions
- Documents all correspondence and conversations with insurance companies, government agencies, patients, and other customers on patient's account or phone log as appropriate
- Review no-response work queues with third party payer vendor to aid with resolving outstanding claims
- Conducts account history research as required, including navigating patient encounters and charts, researching charge and payment histories, determining historic account and claim status changes, and researching payer remittance advice. Some focus will be dedicated to complex accounts or payers
- Conducts follow up research on underpaid claims to review contract discrepancy. Escalates and forwards any Epic or legacy contract management issues encountered to supervisors or the appropriate department as directed
- Reviews appropriateness of account balances and resolve discrepancies as necessary, including attaching documentation, amending coverage/patient/encounter/provider/facility data, gathering additional information requests, and resubmitting corrected claims
- Forwards denials to appropriate Epic work queue for other functional expertise, outsourced business partner where required
- Stays informed about and interprets updates in Medicare, Medicaid, and Health Safety Net policies; monitors changes in RAC (Recovery Audit Contractor) requirements and raises any potential concerns.
- Monitor and provide updates on outstanding accounts receivable balances in Epic for insurance, self-pay, and credits to ensure timely resolution.
- Ability to report on all changes that affect the workgroup to Manager and other appropriate management within the Revenue Cycle operations team.
- Advises management of any potential compliance issues immediately
- Adheres to and maintains an up to date knowledge of billing and claim processing regulations, policies, and procedures
- Adheres to and maintains an up to date knowledge of all relevant state and federal laws regarding medical billing, including HIPAA privacy and security regulations
- Adheres to and maintains an up to date knowledge of all relevant BMC’s policies and procedures, including confidentiality policies and sexual harassment policies
- Attends in-services and payer seminars and keeps abreast of current issues affecting reimbursement, billing and collection. Maintains files and documentation of current regulations and guidelines.
Must adhere to all of BMC’s RESPECT behavioral standards.
JOB REQUIREMENTS
EDUCATION:
Bachelor’s degree in Business/Healthcare related field preferred or equivalent combination of formal education and work experience.
CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:
None
EXPERIENCE:
Work requires knowledge health care billing and collection process including federal and state collection laws, legal collection practices and collection techniques at a level generally acquired through 2 to 3 years on-the-job training or experience in billing Medicare, Medicaid, Blue Cross, HMO, Commercial insurance in a healthcare environment.
KNOWLEDGE AND SKILLS:
- Knowledge of and experience with Epic Resolute is preferred
- General knowledge of medical billing and collections processes preferred
- General knowledge of healthcare terminology preferred
- Knowledge of contracted payers preferred
- Demonstrates proficiency in Microsoft Suite applications, specifically Excel and Word applications, as well as Outlook
- Demonstrates technical proficiency within Resolute Hospital and Professional billing; position requires ability to navigate various modules within Epic to perform account research
- Ability to navigate payer website / portals to perform remittance research and gather additional information needs
- Proficiency with medical billing and remittance forms and processes, including 835 and 837 files, and UB04 and CMS-1500 (HCFA) forms
- Position may require proficiency with BMC’s legacy systems
IND123
Compensation Range:
$62,500.00- $91,000.00
This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensures as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, BMCHS offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), discretionary annual bonuses and merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family well-being.
NOTE: This range is based on Boston-area data, and is subject to modification based on geographic location.
Equal Opportunity Employer/Disabled/Veterans
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