Beth Israel Lahey Health
Patient Financial Services Senior Specialist - Hospital Billing
Beth Israel Lahey Health, Boston, Massachusetts, us, 02298
Overview
Patient Financial Services Senior Specialist - Hospital Billing role at Beth Israel Lahey Health. The Senior Specialist will handle high‑complexity Accounts Receivable within Hospital Billing, Denial, & Follow-Up queues, provide guidance to the staff, ensure compliance and maximize reimbursement. Works under supervision of the Department Manager. Responsibilities
Utilizes the Epic Hospital Billing System to review and monitor accounts through the Billing, Denial, & Follow-Up work queues. Investigate and resolve assigned accounts of the highest level of complexity (inpatient, high dollar, aged accounts) within Hospital Billing, Denial, & Follow-Up work queues to completion and communicate to the Manager within the designated time frame (essential). Contact insurance carriers or other responsible parties to determine what is needed for complete and accurate appeal documentation and follow through to time of payment posting. Gather all necessary documentation needed to have claims reprocessed/adjudicated. Inform and/or transfer to management any problem accounts and/or denial trends that require escalation within 2 days of identification. Document all actions taken within the Epic account notes section and/or follow up/denial activities note sections. Adhere to all Hospital Billing, Follow up, and Denial departmental policies and procedures/training documents. Complete necessary training sessions required for the Hospital Billing system and demonstrate good working knowledge to successfully resolve assigned accounts within Follow Up and Denial work queues. Participate in educational shadowing sessions and workflow adherence as requested by Management. Document inactive periods and make them available upon management's request. Resolve accounts with the highest level of complexity in any Claims Edit work queue and resubmit claims through the Epic Billing System. Work assigned accounts with the highest level of complexity within claim edit work queues daily and resubmit claims through the Epic billing system. Handle External claim edits from Clearinghouse and resubmit claims through the Epic billing system. Process Paper claims with proper documentation for the highest level of complexity. Communicate all claims/data problems to the Manager within one day of identifying the issue(s). Identify and research all incomplete or inaccurate information on claims and escalate as needed. Handle payer 277 rejections on high-complexity accounts and resubmit claims through Epic Billing system or other submission methods; provide trends to management for payer outreach and internal system updates to ensure timely filing and reimbursement. Education and Licensure
Education: High School Diploma / GED Required Licensure, Certification & Registration: None Required Experience
At least seven (7) years accounts receivable experience required Skills, Knowledge & Abilities
Demonstrates attention to detail and prioritization of accounts Strong working knowledge of Epic Hospital Billing Follow Up and Denial workflows; SME to team and colleagues Strong oral and written communication Professional telephone & email etiquette Ability to interact with insurance carriers, patients, and colleagues professionally Excellent billing computer and PC skills Strong problem solving and decision making skills Ability to resolve account issues to completion and obtain appropriate payment Ability to work independently and efficiently Preferred Qualifications & Skills
Experience in Revenue Cycle Accounts Receivable Experience working with EPIC As a health care organization, we have a responsibility to protect our patients, colleagues and communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment. Learn more about this requirement. Equal Opportunity Employer/Veterans/Disabled
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Patient Financial Services Senior Specialist - Hospital Billing role at Beth Israel Lahey Health. The Senior Specialist will handle high‑complexity Accounts Receivable within Hospital Billing, Denial, & Follow-Up queues, provide guidance to the staff, ensure compliance and maximize reimbursement. Works under supervision of the Department Manager. Responsibilities
Utilizes the Epic Hospital Billing System to review and monitor accounts through the Billing, Denial, & Follow-Up work queues. Investigate and resolve assigned accounts of the highest level of complexity (inpatient, high dollar, aged accounts) within Hospital Billing, Denial, & Follow-Up work queues to completion and communicate to the Manager within the designated time frame (essential). Contact insurance carriers or other responsible parties to determine what is needed for complete and accurate appeal documentation and follow through to time of payment posting. Gather all necessary documentation needed to have claims reprocessed/adjudicated. Inform and/or transfer to management any problem accounts and/or denial trends that require escalation within 2 days of identification. Document all actions taken within the Epic account notes section and/or follow up/denial activities note sections. Adhere to all Hospital Billing, Follow up, and Denial departmental policies and procedures/training documents. Complete necessary training sessions required for the Hospital Billing system and demonstrate good working knowledge to successfully resolve assigned accounts within Follow Up and Denial work queues. Participate in educational shadowing sessions and workflow adherence as requested by Management. Document inactive periods and make them available upon management's request. Resolve accounts with the highest level of complexity in any Claims Edit work queue and resubmit claims through the Epic Billing System. Work assigned accounts with the highest level of complexity within claim edit work queues daily and resubmit claims through the Epic billing system. Handle External claim edits from Clearinghouse and resubmit claims through the Epic billing system. Process Paper claims with proper documentation for the highest level of complexity. Communicate all claims/data problems to the Manager within one day of identifying the issue(s). Identify and research all incomplete or inaccurate information on claims and escalate as needed. Handle payer 277 rejections on high-complexity accounts and resubmit claims through Epic Billing system or other submission methods; provide trends to management for payer outreach and internal system updates to ensure timely filing and reimbursement. Education and Licensure
Education: High School Diploma / GED Required Licensure, Certification & Registration: None Required Experience
At least seven (7) years accounts receivable experience required Skills, Knowledge & Abilities
Demonstrates attention to detail and prioritization of accounts Strong working knowledge of Epic Hospital Billing Follow Up and Denial workflows; SME to team and colleagues Strong oral and written communication Professional telephone & email etiquette Ability to interact with insurance carriers, patients, and colleagues professionally Excellent billing computer and PC skills Strong problem solving and decision making skills Ability to resolve account issues to completion and obtain appropriate payment Ability to work independently and efficiently Preferred Qualifications & Skills
Experience in Revenue Cycle Accounts Receivable Experience working with EPIC As a health care organization, we have a responsibility to protect our patients, colleagues and communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment. Learn more about this requirement. Equal Opportunity Employer/Veterans/Disabled
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