Revenue Cycle Business Partner I

BMC Software

1d•$62,500 - $91,000•Onsite

About The Position

Under the supervision of a Senior Manager of Vendor Management, the Revenue Cycle Business Partner I supports revenue operations through administrative and analytical work that promotes accurate billing, timely reimbursement, and regulatory compliance for hospital and professional claims. The role handles claim correction, submission, and billing activities, and works with insurance payers and third-party vendors to resolve claim adjudication issues. It manages billing work of moderate complexity, including tasks requiring knowledge of claim processes and payer contracts, and serves as a knowledge resource to other Revenue Cycle Department staff. The position follows quality assurance guidelines and productivity standards to support team performance and accurate, timely claim submission and payment. The role analyzes revenue cycle data, reports on performance indicators, researches and resolves claim and account issues, and collaborates with vendors and internal teams. It also monitors applicable billing regulations and payer-policy updates, maintains relevant knowledge of laws and organizational policies, and promptly alerts management to potential compliance issues. The position is full-time in Quincy, Massachusetts, in the PFS Administration department.

Requirements

Knowledge of healthcare billing and collection processes, including federal and state collection laws, legal collection practices, and collection techniques, generally acquired through 2–3 years of on-the-job training or experience billing Medicare, Medicaid, Blue Cross, HMO, and commercial insurance in a healthcare environment.
Proficiency with Microsoft Suite applications, specifically Excel, Word, and Outlook.
Technical proficiency with Resolute Hospital and Professional billing and the ability to navigate various Epic modules for account research.
Ability to navigate payer websites and portals to research remittances and gather additional information.
Proficiency with medical billing and remittance forms and processes, including 835 and 837 files and UB04 and CMS-1500 (HCFA) forms.
Position may require proficiency with BMC legacy systems.
Must adhere to BMC’s RESPECT behavioral standards.

Nice To Haves

Bachelor’s degree in a business- or healthcare-related field, or an equivalent combination of formal education and work experience.
Knowledge of and experience with Epic Resolute.
General knowledge of medical billing and collections processes.
General knowledge of healthcare terminology.
Knowledge of contracted payers.

Responsibilities

Compile, analyze, and interpret revenue cycle data to identify trends, patterns, and process-improvement opportunities.
Generate reports and dashboards tracking key performance indicators for billing, collections, and reimbursement.
Provide data-based insights and recommendations to improve revenue cycle performance and efficiency.
Work with vendors on late charges, including submitting late-charge or late-replacement claims with the appropriate Type of Bill.
Participate in internal audits and quality assurance activities to maintain compliance and process integrity.
Review, reconcile, and correct edits received from the organization’s clearinghouse, including complex accounts or payers.
Contact insurers, government agencies, patients, and other customers professionally by phone, email, or written correspondence to obtain or provide information needed for claim submission and resubmission.
Use insurance and third-party websites to gather required information.
Answer customer questions about billing and payments professionally.
Document correspondence and conversations with insurers, government agencies, patients, and other customers in the patient account or phone log as appropriate.
Review no-response work queues with third-party payer vendors to help resolve outstanding claims.
Research account histories, patient encounters and charts, charge and payment histories, account and claim status changes, and payer remittance advice, including complex accounts or payers.
Research underpaid claims for contract discrepancies and escalate Epic or legacy contract-management issues to supervisors or the appropriate department.
Review account balances and resolve discrepancies, including attaching documentation, amending coverage, patient, encounter, provider, or facility data, gathering requested information, and resubmitting corrected claims.
Forward denials to the appropriate Epic work queue or outsourced business partner for further expertise when required.
Stay informed about Medicare, Medicaid, and Health Safety Net policy updates; monitor Recovery Audit Contractor requirements and raise potential concerns.
Monitor and provide updates on outstanding insurance, self-pay, and credit accounts receivable balances in Epic to support timely resolution.
Report changes affecting the workgroup to the Manager and other appropriate Revenue Cycle operations management.
Promptly advise management of potential compliance issues.
Maintain current knowledge of billing and claim-processing regulations, policies, procedures, and applicable state and federal medical-billing laws, including HIPAA privacy and security regulations.
Maintain current knowledge of organizational policies and procedures, including confidentiality and sexual harassment policies.
Attend in-services and payer seminars, stay current on reimbursement, billing, and collection issues, and maintain files and documentation of current regulations and guidelines.
Adhere to BMC’s RESPECT behavioral standards.