Schedule Details:

Scheduled Hours:

Shift:

Hours:

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

At UMass Memorial Health, everyone is a caregiver - regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 16,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.

Responsible for verifying coverage and charges, working edits, submitting claims, resolving denials, following up on outstanding accounts receivable and all other tasks related to specialty billing.

Major Responsibilities:

• Analyzes and researches failed claim edits and work with departments and payers to resolve the edit within established timeframes, policies and procedures. Uses reference material to troubleshoot edits and gain additional understanding.
• Escalates trends and additional edits internally, to promote claim accuracy and quality applicable to Hospital Billing Revenue Cycle management system, claim submission system, and payor claims processing systems.
• Troubleshoots issues, providing root cause analysis and recommends potential solutions.
• Works with clinical areas as needed to validate data and/or escalate outstanding issues to ensure proper claim submission, reimbursement and resolution.
• Ensures timely resolution to all accounts receivable utilizing assigned work queues. Follows prioritization standards. Resolves edits in the adjunct claim submission application.

Position Qualifications:

License/Certification/Education:

Required:

• High School diploma

Experience/Skills:

Required:

• Three or more years of experience in health care billing functions.
• Previous health care billing experience.
• Advanced knowledge of specialty billing requirements related to claims and reimbursement policies.

• Basic clinical knowledge of specialty billing areas including but not limited to Research, Clinical Trials, Client, Transplant, Bone Marrow Transplant, Solid Organ Transplant, and Dental.
• Ability to work collaboratively and effectively with people.
• Exceptional communication and interpersonal skills.

• Ability to work independently, exercise good judgment to ensure compliant claims submission.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

We're striving to make respect a part of everything we do at UMass Memorial Health - for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.

As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.

If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at talentacquisition@umassmemorial.org. We will make every effort to respond to your request for disability assistance as soon as possible.