Billing - Baystate Health

Req#: R30822
Category(s): Finance, Billing
Full Time / Part Time: Full-Time
Shift: First

Summary: 

Reports directly to Practice Leadership as designated by the Director. May receive directions from the Practice Supervisor, Practice Manager, and other members of the Service Line/Department leadership team. The Ambulatory Billing Specialist acts as a liaison between the Physicians’ Billing Office/ Hospital Revenue Cycle teams and physicians and their staff;  communicates concerns with internal and external management. Responsible for regional and/or high complexity billing charge capture. Coordinates staff and providers in the department to ensure billing charge capture for all assigned locations. The incumbent is also responsible for identifying and rectifying all outstanding charge issues to ensure claims are billed timely and accurately.

Job Responsibilities: 

1) Coordinates staff and providers in the department to ensure billing charge capture for all assigned locations.

Assembles, analyzes and adds/edits charges accurately in a timely manner.  Follows ICD-10 and CPT guidelines, coding diagnoses and procedures as required.  Processes billing edit reports and other errors for complete, accurate and timely filing of claims.

2) Acts as a liaison between physicians, the Physicians’ Billing Office/Revenue Cycle teams, HIM, physicians and their staff.

Informs the PBO and Revenue Cycle of billing issues within the Department and follows up in a courteous and professional manner. Trains and guides clerical and medical staff with billing and insurance concerns as necessary or directed.  Reports accurate end of the month statistics to physicians and administrative staff. 

Identifies recurring rejections, edits, etc and other trends to leadership for research and practice follow-up. 

Attends meetings and seminars as required or directed.

3)  Acts as a liaison for telephone calls and correspondence related to billing, insurance, referrals and prior authorizations. Coordinates with billing office in resolving billing inquiries from patients.

4)  Maintains billing reports and logs according to departmental procedures. Performs on line, (SMS, Patient Keeper, etc.), entry of account changes and communicates these changes to others (as necessary). Communicates issues to clinicians and management as required.

5)  Maintains a strong working knowledge of all applicable BHS systems as defined by the Department or Service Line, including but not limited to registration and billing. Responsible for training and diseminanting updated information for registration and billing.

6)  Whenever possible, resolves TES Edits at time of charge entry, reporting any unusual edits to supervisor/manager for review. Resolves all edits in a timely manner. Ability to complete high complexity TES Edits.

7)  Demonstrates and maintains a thorough knowledge of third party payer guidelines relevant to hospital revenue cycle procedures for selected departments. Responsible for training support staff on third party payer guidelines and disseminating all updates to those guidelines.

8)  Proactively identifies opportunities to improve prepping and/or charge entry processes and makes recommendations to the supervisor and/or manager. Responsible for implementation of processes in coordination with practice leadership.  

9)  Organizes documentation and billing reports and partners with providers and manager to ensure timely documentation and charge submission

10)  Reviews and ensures that all charge tickets are prepared, batched, and charge entered appropriately using the appropriate established procedures.  Communicate effectively with the practices, providers, or BMC managers to resolve any discrepancies

11) Enters charges, co-pays and self pays when applicable into the appropriate system(s).    

12)

General Service Excellence Principles.

Identifies the key elements of service excellence.  Successfully deal with challenging day to day interactions with patients, families, visitors, and customers (i.e. physicians, staff, etc.) in a consistent manner.  

Consistently uses service excellence behaviors as evidenced by no legitimate complaints received from patients, families, and/or providers. 

Identifies and respects the needs of the internal and external customers.  Maintains the patients/customers sense of self worth and dignity in difficult situations.  Maintains a calm, controlled approach at all times. 

Consistently projects image of Baystate’s services and systems in a positive manner..

13)Patient/Customer First.

Communicates to patients/customers that they are a high priority even during busy times.  Treats patients' information confidentially.  Shows patients/customers that she/he believes that they are important.  Shows sensitivity to the patients/customers non-verbal communication.  Maintains the patients/customers sense of self worth and dignity in difficult situations.  Facilitates access to services

14)Judgment and Empathy

Assesses the potential impact on the patient/customer when making a decision.  Develops alternatives when the best course of action is not available.  Acknowledges what the patient and customer has said. 

Summarizes and demonstrates that he/she has listened to the patient/customer.  Empathizes with the patient/customer.  Identifies resources. 

Uses body language such as eye contact, smiling, etc. to demonstrate interest

15) Performs duties and job functions in accordance with the policies established for the department and all other duties as assigned

Required Work Experience: 

1) Minimum of 3 years medical billing and/or medical coding

Preferred Work Experience: 

1)  Knowledge of medical terminology, current third party billing and collection regulatory guidelines.

Skills and Competencies: 

Superior Customer Service with emphasis on grammar, spelling and vocabulary to be utilized in patient, insurance, and physician correspondence. Strong understanding of insurance requirements relating to the submission of claims.

Ability to work independently and maintain the highest levels of confidentiality

Attention to detail, strong organizational skills; Ability to respond to changing priorities as needed.

Proficient in Excel. 

Ability to work independently in a fast paced environment.  Ability to work with Leadership Team on projects as needed.  Ability to meet all business requirements as dictated by third party payers. Advanced attention to detail and communication skills. 

Interest and ability to cross-train in other disciplines to enhance unit’s effectiveness as a team in situations where coordination and back-up are necessary.

You Belong At Baystate

At Baystate Health we know that treating one another with dignity and equity is what elevates respect for our patients and staff. It makes us not just an organization, but also a community where you belong. It is how we advance the care and enhance the lives of all people.

DIVERSE TEAMS. DIVERSE PATIENTS. DIVERSE LOCATIONS.

Education:

GED or HiSET: Medical Billing & Coding (Required)

Certifications:

Equal Employment Opportunity Employer

Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.

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