AR Specialist II - REMOTE

Everyone Is a Caregiver

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 20,000 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 follow-up of complex surgical/procedural/multidisciplinary specialty claims for payments including coding and analyzing claims and claim payments/rejections.

Major Responsibilities:

1. Contacts insurance companies, while working detailed reports, to secure outstanding payments, i.e. telephone calls, websites, written appeals.

2. Reviews complex rejections in assigned payors and plans to determine validity of rejections and take appropriate action to resolve.

3. Monitors changes in reimbursement policies, including payor fee schedule reconciliation.

4. Performs special projects as assigned by manager or supervisor defining problems, determining work sequence and summarizing findings.

5. Calculates and posts adjustments based on third party reimbursement guidelines and contracts.

6. Makes appropriate payor and plan changes to secondary insurers or responsible parties.

7. Inputs missing data as required and corrects registration and other errors as indicated.

Standard Staffing Level Responsibilities:

1. Complies with established departmental policies, procedures and objectives.

2. Attends variety of meetings, conferences, seminars as required or directed.

3. Demonstrates use of Quality Improvement in daily operations.

4. Complies with all health and safety regulations and requirements.

5. Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.

6. Maintains, regular, reliable, and predictable attendance.

7. Performs other similar and related duties as required or directed.

All responsibilities are essential job functions.

Position Qualifications:

License/Certification/Education:

Required: 1. High School Diploma

Experience/Skills:

Required: 1. Two years of previous Revenue Cycle knowledge including PFS, Customer Service, Cash Posting, Financial Assistance, Patient Access, HIM/Coding and/or 3rd party reimbursement.

2. Knowledge of multiple third-party regulations, ICD, CPT and HCPCS coding and modifier assignment. Knowledge of billing and reimbursement practices/requirements of major third-party payors in Massachusetts.

3. Knowledge of medical terminology, anatomy & physiology and disease process.

4. Ability to organize and prioritize work to meet strict deadlines.

5. Computer skills to include mainframe, PC applications and excel.

6. Must be self-motivated, service oriented and have excellent communication skills (written and oral).

7. Physician coding certification is desired.

Preferred: 1. Three years of physician or medical billing experience involving complex surgical/procedural/multidisciplinary specialties.

Unless certification, licensure or registration is required, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements.

Department-specific competencies and their measurements will be developed and maintained in the individual departments. The competencies will be maintained and attached to the departmental job description. Responsible managers will review competencies with position incumbents.

Physical Demands and Environmental Conditions:

Work is considered sedentary. Position requires work indoors in a normal office environment.

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.