Accounts Receivable Specialist II

UMass Memorial Health • Worcester, MA

2d • $21 - $34

About The 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. Responsible for follow-up of complex surgical/procedural/multidisciplinary specialty claims for payments including coding and analyzing claims and claim payments/rejections. Responsible for follow-up of complex surgical/procedural/multidisciplinary specialty claims for payments including coding and analyzing claims and claim payments/rejections.

Requirements

• High School Diploma
• Two years of previous Revenue Cycle knowledge including PFS, Customer Service, Cash Posting, Financial Assistance, Patient Access, HIM/Coding and/or 3rd party reimbursement.
• Knowledge of multiple third-party regulations, ICD, CPT and HCPCS coding and modifier assignment.
• Knowledge of billing and reimbursement practices/requirements of major third-party payors in Massachusetts.
• Knowledge of medical terminology, anatomy& physiology and disease process.
• Ability to organize and prioritize work to meet strict deadlines.
• Computer skills to include mainframe, PC applications and excel.
• Must be self-motivated, service oriented and have excellent communication skills (written and oral).

Nice To Haves

• Physician coding certification is desired.
• Three years of physician or medical billing experience involving complex surgical/procedural/multidisciplinary specialties.

Responsibilities

• Contacts insurance companies, while working detailed reports, to secure outstanding payments, i.e. telephone calls, websites, written appeals.
• Reviews complex rejections in assigned payors and plans to determine validity of rejections and take appropriate action to resolve.
• Monitors changes in reimbursement policies, including payor fee schedule reconciliation.
• Performs special projects as assigned by manager or supervisor defining problems, determining work sequence and summarizing findings.
• Calculates and posts adjustments based on third party reimbursement guidelines and contracts.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees