PRE-BILLING & CLAIMS ASSOC I (DAYS)

Caregiver Position

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.

Supports the timely and accurate submission of claims using provided reference material to resolve claim edits supporting timely claim submission.

Major Responsibilities:

• Prioritizes standards and guidelines to perform pre-billing and claims submission processes utilizing assigned work queues.
• Sorts, distributes and processes primary and secondary paper claims. Ensures appropriate attachments are included leveraging available technology if possible. Documents action taken as appropriate in the Hospital Billing revenue cycle management system.
• Submits electronic claims using the claims submission system in accordance with payer requirements.
• Resolves edits in the claim submission application.
• Uses provided reference material to troubleshoot edits and gain additional understanding of payer claim submission requirements.
• References payer websites as needed to acquire knowledge and understanding of appropriate follow up actions.
• Communicates and works with other team members collaboratively to understand and resolve claim edits and issues.
• 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.
• Utilizes payer websites to identify claim submission requirements and communicate accordingly.
• Works specialty claims according to instruction and work with departments to resolve issues on a timely basis.
• Meets established productivity standards.
• Facilitates and promotes the sharing of knowledge and content throughout departments.
• Participates in cross training to optimize billing resources.
• Maintains and fosters an organized, clean, and safe work environment.
• Maintains a collaborative, team relationship with peers and colleagues in order to effectively contribute to the group's achievement of goals and to help foster a positive work environment.
• Practices cost containment and fiscal responsibility through the efficient use of supplies, equipment, time, etc.

Standard Staffing Level Responsibilities:

• Complies with established departmental policies, procedures and objectives.
• Attends variety of meetings, conferences, seminars as required or directed.
• Demonstrates use of Quality Improvement in daily operations.
• Complies with all health and safety regulations and requirements.
• 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.
• Maintains, regular, reliable, and predictable attendance.
• Performs other similar and related duties as required or directed.

All responsibilities are essential job functions.

Position Qualifications:

License/Certification/Education:

• Required: High School diploma
• Experience/Skills: Required: Previous Revenue Cycle knowledge in one of the following areas including PFS, Customer Service, Cash Posting, Financial Assistance, Patient Access, HIM/Coding and/or 3rd party Reimbursement. Ability to perform assigned tasks efficiently and in timely manner. Ability to work collaboratively and effectively with people. Exceptional communication and interpersonal skills.
• Preferred: One or more years of experience in health care billing functions.

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.

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.

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.