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Sr Assoc, Physician Billing

Boston Children's Hospital

Boston, MA

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JOB DETAILS
SKILLS
Billing, Claims Processing, Demographics, Detail Oriented, Establish Priorities, Federal Laws and Regulations, Government Regulations, High Reliability, Identify Issues, Information Technology & Information Systems, Insurance, Insurance Claims, Medical Billing, Organizational Skills, Payment Posting, Problem Solving Skills, Regulatory Requirements, Secondary School, Staff Training, Team Player, Third-Party Payer, Time Management, Training/Teaching
LOCATION
Boston, MA
POSTED
9 days ago
Position Summary

With limited supervision, responsible for the timely and accurate submission of all charges and claims as assigned and required to bring issue/problem identification and investigation through to an accepted/successful resolution. Ensures that daily assignments are complete and that all assigned work is reviewed, submitted, and resolved with the highest degree of accuracy.
Key Responsibilities
  • Reviews and verifies all demographic and insurance information utilizing available technologies, payer websites, or by phone contact with third party payers or guarantors.
  • Collaborate with management and peers to ensure all required information is obtained for resolution of charge edits, claim edits, denials, and appeals in a timely manner, while adhering to government/payer regulation and department policy/procedures.
  • Prepares and submits accurate insurance claims and appeals to payer within required timeframes and in accordance with government/payer regulations and requirements.
  • Resolves outstanding charges and claims responding timely and accurately for resolution of outstanding balance while adhering to department policies/procedures.
  • Accepts, rejects, and reconciles claims run on timely basis and processes payer response reports in an effective and timely manner.
  • Reviews and processes guarantor overpayments per department policies and procedures.
  • Responds to inquiries received via telephone and other correspondence from patients/guarantors, insurance carriers, departments/foundations as needed.
  • Assist with the training of newly hired staff in process and system navigation
Knowledge and Skills
  • Ability to perform at a high level of reliability in all duties.
  • Attention to detail, good organizational skills, ability to meet priorities within set timeframes, and ability to work as part of a team.
  • Applies critical and strategic thinking.
  • Knowledge of consumer & federal rights and regulations.
  • Comprehensive ability and knowledge of electronic claims processing, electronic remittance advice, electronic payment posting, and clearinghouse functions.
  • Thorough knowledge and understanding of benefits and/or coverage as indicated by third party payer requirements.
  • Knowledge of insurance authorizations in relation to medical billing.
  • Ability to identify problems and issues of varying complexities and to find effective solutions with few guidelines.
  • Ability to take initiative to complete moderately complex assignments.
  • Demonstrates professional integrity.
  • Ability to train and support other team members.
Education
  • High School / GED
Experience
  • 2 years of experience in a multi-specialty physician billing or equivalent medical billing experience

About the Company

B

Boston Children's Hospital

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