The Opportunity:

Reporting directly to the Team Supervisor/Manager and under the general direction of the Billing & Accounts Receivable Manager, the Billing Representative II performs a variety of billing functions to minimize accounts receivable and enhance collection performance. This position is relied upon to work on any activity within the team with little or no direct supervision. Utilizes electronic billing and medical retrieval systems and in-depth knowledge of medical billing and insurance rules and regulations to resolve accounts receivable issues. Assist Team Supervisor/Manager with specified duties.

Principal Duties and Responsibilities:

• Achieve excellence in performance by working collaboratively with others on MGB RCO Professional Billing Office initiatives.
• Supports and demonstrates the values of Massachusetts General Brigham by conducting activities ethically with integrity, honesty, and confidentiality. Demonstrates a positive, open-minded, can-do attitude. Represents a team perspective and willingness and enthusiasm to collaborate with others. Follows through on commitments and achieves desired results. Exhibits sound judgment, obtains the facts, examines options, gains support, and achieves positive outcomes.
• Always maintain high professional conduct standards. Represents the MGB RCO at events and projects external to the organization.
• Enthusiastically promote a cooperative team environment to provide value to all customers. Act as a leader in creating a positive atmosphere within the team. Listen and interact tactfully, diplomatically, and effectively without alienating others.

Account Management

• Perform all aspects of the Billing Representative I position at a consistently high degree of proficiency. This entails a complete understanding of all department policies and procedures to execute all billing tasks with minimal direct supervision. This representative is expected to be a leader within the team in productivity, teamwork, efficiency, communication, and patient care. Act with minimal supervision, notice or direction to identify and resolve problems and complete work.
• Work the most sensitive Epic Workqueues, projects and/or accounts and provide immediate feedback to Team Supervisor on changes or modifications that need to be communicated to appropriate Liaison/department.
• Apply knowledge of insurance rules and regulations to interpret new insurance/HCFA/HIPAA information and report potential impact. Utilize experience and expertise to determine the correct course of action efficiently and effectively on each account/project.
• Effectively handle telephone inquiries from insurance companies and other departments within the RCO. Gather and interpret all relevant information to help resolve issues or complaints. Document issues thoroughly.
• Apply transfers and/or adjustments to invoices as needed to complete each invoice's resolution.
• Request necessary data as appropriate to resolve issue and trends once identified within their work files and follow through on resolutions to completion.
• Represent the department in meetings with other RCO or MGB staff and Insurance Representatives.
• Coordinate data to complete special billing projects based on contractual obligations and regulatory demands .
• Meet deadlines and productivity standards for Epic Workqueues, including but not limited to:
  1. Insurance verification
  2. Referral Management
  3. C orrespondence & phone inquiries
  4. Billing/mailing claims/appeals
  5. Working claim edits & scrubbers
  6. Third party follow-up including secondary billing & rejections
  7. Special projects
• Demonstrate proficiency with a variety of automations, including but not limited to EPIC and PCIS, PATCOM, Microsoft Word, Excel, E-mail, Voicemail and Payor Websites.
• Participate in continuous quality improvement efforts. Establish goals with Team Supervisor/Manager and track progress.
• Comply with hospital confidentiality policy. Manage special projects as assigned.
• Perform other duties as assigned

Qualifications

• High School diploma or GED equivalent required
• 1 year of experience in high volume medical billing and Billing/Accounts Receivable systems required.
• Epic knowledge preferred
• Effective communication, organizational and problem-solving skills
• Detailed working knowledge of medical terminology, ICD 10 coding and CPT, HCPCS preferred.

Skills and Abilities

• Excellence in customer service skills
• Effective communication and interpersonal skills to successfully interact with internal and external customers
• Effective organizational and problem-solving skills
• Ability to manage multiple tasks/projects simultaneously
• Demonstrated proficiency with a variety of automations, including but not limited to Epic, PATCOM, Meditech, INVISION, LMR, Microsoft Word, Excel, Email, and electronic data processing skills
• Established as a dynamic and positive team player, able to work independently and in a group/team setting
• Knowledge of medical billing, insurance rules and regulations required
• Detail oriented
• Adapt positively to changes in the work setting with ease

Schedule: Full-time Time of Day: M-F Eastern Hours Hybrid role includes a variable scheduled for business need. Up to 4x a month onsite upon request for business need remote work requires stable, secure, quiet, compliant work area. Standard Hours: 40 Shift: Day Job