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Third Party Accounts Receivable Specialist

Tufts Medical Center – Boston, MA

Under general supervision this position is responsible for the entire receivable assigned to the Third Party Accounts Receivable Specialist, including verification, billing, analysis, follow-up, denial and appeal processing, and account closure for assigned third party payers.
Performs day-to-day clerical 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.
Conducts follow-up of outstanding account balances with assigned payers and takes action for resolution.
Reviews, evaluates and processes all appeals through research and resubmission to appropriate third party of complete and accurate supporting documentation.
Recommends/performs third party adjustments and write-offs to Team Leader or Supervisor.
Responsible for researching and handling all rejections, including understanding why a claim rejected, how it must be fixed, whether the patient is now liable or whether the hospital is liable. Must initiate any corrective action, including referral to the supervisor when appropriate.
Responsible for the processing of adjustments due to denials, contractual requirements, and credit balances.
Resolves assigned accounts in a timely and accurate manner, which maximizes reimbursement in compliance with assigned payer regulations and department s policy and procedure.
Maintains knowledge of federal/State documentation and payer requirements along with annual updates to CPT/ICD-10 coding guidelines.
Regular interaction with other departments of the hospital using electronic system tools to resolve accounts, including Medical Records, Physician s Offices, Utilization Review and Preadmission office.
Interacts on a daily basis over the phone and through correspondence with assigned payers. Establishes working relationships with payer representatives to facilitate processing Tuft MC or PO service accounts.
Consistently achieves and maintains performance standards for assigned productivity, collections, and quality targets.
Identifies trends in workflows and rework, and report outstanding operational issues to management for further research and resolution.
Performs other similar and related duties as required or directed.
High school diploma or equivalent required
Minimum of two years of experience in an automated medical billing and collection environment for a medical services provider and/or third party payer
Working knowledge of billing requirements for assigned payers.
Ability to systematically analyze problems, draw relevant conclusions and devise appropriate course of action
Ability to analyze data, perform multiple tasks and work independently.
Good interpersonal skills in written and verbal form are required.
Must be able to develop and maintain professional, service-oriented working relationships with senior leadership, patients, physicians, co-workers and employees.
Ability to work in a fast paced environment, with focus on team building and productivity.
System Experience:
Required: Microsoft Outlook, Microsoft Word, Microsoft Excel
Preferred: \Siemens (Invision), GE/IDX, Huron-Trac/Quic, Epremis, FSS (Medicare Billing), Care Medic (Medicare Billing), NDC (Inpatient & Outpatient Billing), PC Print (Medicare EOB print), CMS (Commercial EOB print)
A comprehensive working knowledge of the application of Commercial, Workers Compensation and other third party payer rules, regulations, guidelines and requirements for billing, collection and reimbursement appeals. A basic understanding of how these regulations are applied to Massachusetts providers is desirable.
Ability to learn PC based computer systems, word processing, database and spreadsheet software programs.
Proficient in using computers and navigated through Blue Shield, Medicare and Medicaid and other third party computer/electronic application systems efficiently and effectively.
Good interpersonal and communication skills and a basic understanding of team management concepts.
Completion of a medical terminology course and understanding of CPT and ICD diagnosis coding preferred.
Billing and accounts receivable software knowledge desired.
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