Revenue Integrity Billing Specialist

Boston, MA, United States

When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives.

Job Type:

Regular

Scheduled Hours:

40

Work Shift:

Day (United States of America)

The Revenue Integrity Billing Specialist role specializes in enrollment & revenue integrity issues relating to professional billing. This role is responsible to maintain provider profiles in Epic for correct revenue flow of charges and billing. The Billing Specialist will be responsible for charge and claim review to ensure correct information is on file for charge to post and bill appropriately. The Billing Specialist will work directly with Service Line Directors, Finance Directors, Practice Managers and Provider Enrollment teams within BILH to obtain required information. The Billing Specialist will educate Directors & Managers on workflows to help optimize revenue flow and prevent denials downstream for assigned areas. The Billing Specialist will also work enrollment related issues and serve as the primary liaison to the appropriate departments and teams to correct these issues in a timely manner. This role requires attention to detail, logical thinking, analysis of root cause issues, and knowledge of claim requirements for professional billing.

Job Description:

Essential Duties & Responsibilities including but not limited to:

1. Responsible to work and resolve all front-end related work queues. Reviews and completes continuous daily work queue volume for provider & enrollment related edits.

2. Research & request required updates to the Epic SER and initiates rebilling or denials explanation back to appropriate billing teams. Outreach to the appropriate stakeholders to obtain necessary information for SER updates.

3. Responsible to work claim rejections due to provider, enrollment, NPI or taxonomy related issues returned by the payor preventing claims submission or causing payor denials.

4. Responsible to work and respond to all customer service inquiries in regards to provider enrollment related patient accounts.

5. Works with various departments throughout the organization and insurance carriers to resolve issues related to provider, enrollment, NPI or taxonomy related issues.

6. Works with Hospital, Professional and Coding Teams when identifying trends that can lead to inappropriate billing or revenue posting incorrectly.

7. Working in a SBO (Single Billing Office), environment the Revenue Integrity Billing Specialist will need to have knowledge in Hospital and Professional Billing in order to assist with questions and accurate routing of charges.

8. Proactively identifies problems and opportunity for improvements related to system usage, training and end user education, practice and user trends and makes recommendations to the PB Management Team.

9. Assists in the development of reporting mechanisms to identify trends and track so that education can be performed to reduce and/or resolve high dollar/high volume values.

10. Completes all assignments per the turnaround standards. Reports unfinished assignments to the Manager.

11. Attends meetings and serves on committees as requested.

12. Achieves exemplary audit results and consistently exceeds productivity standards.

13. Provides and promotes ideas geared toward process improvements within the Central Billing Office.

14. Independently works on the resolution of complex claims issues, denials and appeals.

15. Completes projects and research as assigned.

16. Responsible for the mentoring and training of new and existing staff as it related to enrollment, NPI, SER and taxonomy following policy and procedures.

Secondary Functions:

17. Enhances professional growth and development through in-service meetings, education programs, conferences, etc.

18. Complies with policies and procedures as they relate to the job.

19. Exercises care in the operation and use of equipment and reference materials. Performs routine cleaning and preventive maintenance to ensure continued functioning of equipment. Maintains work area in a clean and organized manner.

20. Refers complex or sensitive issues to the attention to Management, to ensure corrective measures are taken in a timely fashion.

21. Accepts and learns new tasks as required and demonstrates a willingness to work where needed.

22. Assists other staff as required in the completion of daily tasks or special projects to support the department's efficiency.

23. Performs similar or related duties as assigned or directed.

Minimum Qualifications:

Education: Associates Degree required, bachelor's degree preferred. In absence of Associates Degree, additional 4-years in health care revenue cycle will be considered.

Licensure, Certification & Registration: Billing Certification preferred

Experience: 3 years of experience in billing and denial management environment or related field such as enrollment.

Skills, Knowledge & Abilities:

Comprehensive working knowledge of medical/professional billing

Knowledge of CPT, HCPCS, and ICD-10 coding principles.

Knowledge of Epic or related professional billing software

Demonstrates proficiency in the use of excel documents

Ability to define problems, collect data, establish facts, draw reasonable conclusions and/or make recommendations.

Capacity to analyze and think creatively and weigh alternatives.

Demonstrates attention to detail & organizational skills.

Demonstrates skills with multitasking.

FLSA Status:

Non-Exempt

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment. Learn more about this requirement.

More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.

Equal Opportunity Employer/Veterans/Disabled

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