MelroseWakefield Healthcare is a coordinated system of hospitals, physician practices and community-based services providing care for communities throughout north suburban Boston. We are distinguished by the range of clinical care and services we provide locally for the continuum of care in clinical collaboration with Tufts Medical Center, as well as an affiliation with the Lawrence Memorial. Our focus is simple: a better approach to providing health care, we bring together top-quality primary, emergency and specialty care, locally. Everything you and your family need, right in your neighborhood to be your best healthy.

• Under general supervision, this position is responsible for accounts receivables resolution, including, but not limited to, eligibility verification, billing edits, claim edits, payer follow-up, correspondence review, corrected claims, appeals, reimbursement verification, and remittance research for assigned scope of receivables.
• Performs day-to-day 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 on outstanding account balances with assigned receivables and takes appropriate action for resolution.
• Responsible for researching and handling rejections, including understanding why a claim rejected, how it must be fixed, and what party is financially responsible. 
• Must initiate any corrective action, including referral to the Team Lead or Supervisor when appropriate.
• Reviews, evaluates and processes appeals through research and resubmission to appropriate third party with complete and accurate supporting documentation.
• Responsible for the processing of adjustments due to denials and contractual requirements.
• Resolves assigned accounts in a timely and accurate manner, maximizing reimbursement in compliance with assigned payer and government regulations, and provider organization and department policies and procedures.
• Maintains up-to-date knowledge of federal and state regulations and payer requirements along with annual updates to CPT/ICD-10 coding guidelines.
• Interacts on a daily basis over the phone, on the web and through correspondence with payers.  Establishes working relationships with payer representatives to facilitate processing of claims.
• Regular interaction with other departments of the provider organization using electronic system tools to resolve accounts, including Patient Access, Revenue Integrity, Coding, Medical Records, Utilization Review, Hospital Departments, Physician’s Offices, and other Administrative teams.
• Consistently achieves and maintains performance standards for assigned productivity, collections, and quality targets.
• Identifies trends in workflows and rework, and reports outstanding operational issues to management for further research and resolution.

EDUCATION:

• A high school diploma or GED completion is required.
• Completion of a medical terminology course and understanding of CPT and ICD diagnosis coding preferred.
• HFMA CRCR a plus.
• Epic certifications a plus.

EXPERIENCE:

• Minimum of two years of experience in a medical billing and collection environment for a medical services provider and/or third-party payor.
• A comprehensive working knowledge of coverage eligibility and the application of Commercial, Blue Cross, Medicare, Medicaid, Managed Care, and other third party payor rules, regulations, guidelines and requirements for billing, collection and reimbursement. 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 navigating through third party application systems and web portals efficiently and effectively.
• Good interpersonal and communication skills and a basic understanding of team management concepts.
• Epic HB Billing, PB Billing or Insurance Follow-Up a plus.

SKILLS/ABILITIES:

• Working knowledge of billing requirements for assigned payers and/or service specialties.
• 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.
• Active communication and participation with email and meetings
• Technically savvy with use of accounts receivables systems and related applications, email, and spreadsheets.
• 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.

All your information will be kept confidential according to EEO guidelines.

AMERICANS WITH DISABILITIES STATEMENT:

Must be able to perform all essential functions of this position with reasonable accommodation if disabled.

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed, as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. MelroseWakefield Healthcare reserves the right to modify position duties at any time, to reflect process improvements and business necessity.

COVID-19 POLICY:

Please note that effective October 1, 2021, as a condition of employment at MelroseWakefield, all employees and new hires must have received their complete dose of the COVID-19 vaccine, unless they have been granted an exemption.