PRE-BILLING & CLAIMS ASSOCIATE I


  • Location: Worcester, MA
  • Posted: Jun 17, 2019

Job Description


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

Qualifications


License/Certification/Education:

Required:
High School diploma

Experience/Skills:

Required:
1 or more years of experience in health care billing functions.
Knowledge and experience with health care revenue cycle systems and billing tools.
Understanding of health care claim submission processes.
Ability to perform assigned tasks efficiently and in timely manner.
Ability to work collaboratively and effectively with people.
Exceptional communication and interpersonal skills.

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.
Demonstrates excellent attendance and actively participates in a variety of meetings and training sessions as required.
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 groups 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, and contributes in 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.

UMass Memorial Medical Center

1221 22nd Street
Worcester, MA 01605

Opened: 1998

Web: http://www.umassmemorial.org

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