Third Party A/R Specialist - Patient Financial Services

It takes a lot of very smart, hard-working and talented people to provide the level of care that we give to our patients. Tufts Medical Center is an internationally respected academic medical center and we pride ourselves not only on the sophistication of the care we deliver, but the compassionate way in which we provide it. And that starts with our employees.

Under general supervision this position is responsible for the entire receivable assigned to the 3rd Party AR Specialist, including verification, billing, analysis, follow-up, denial and appeal processing, and account closure for assigned third party payers.

PRINCIPAL DUTIES AND ESSENTIAL FUNCTIONS:

• Performs day-to-day clerical activity to ensure that all information for proper billing is complete and accurate; billing to assigned payers is transmitted or mailed within a timely manner.
• Conducts follow-up of outstanding account balances with assigned payers and takes action for resolution.
• Reviews, evaluates and processes all appeals through research and resubmission to appropriate third party of complete and accurate supporting documentation.
• Recommends/performs third party adjustments and write-offs to Team Leader or Supervisor.
• Responsible for researching and handling all rejections, including understanding why a claim rejected, how it must be fixed, whether the patient is now liable or whether the hospital is liable. Must initiate any corrective action, including referral to the supervisor when appropriate.
• Responsible for the processing of adjustments due to denials, contractual requirements, and credit balances.
• Resolves assigned accounts in a timely and accurate manner, which maximizes reimbursement in compliance with assigned payer regulations and department’s policy and procedure.
• Maintains knowledge of federal/State documentation and payer requirements along with annual updates to CPT/ICD-10 coding guidelines.
• Regular interaction with other departments of the hospital using electronic system tools to resolve accounts, including Medical Records, Physician’s Offices, Utilization Review and Preadmission office.
• Interacts on a daily basis over the phone and through correspondence with assigned payers. Establishes working relationships with payer representatives to facilitate processing Tuft MC or PO service accounts.
• Consistently achieves and maintains performance standards for assigned productivity, collections, and quality targets.
• Identifies trends in workflows and rework, and report outstanding operational issues to management for further research and resolution.
• Performs other similar and related duties as required or directed

JOB KNOWLEDGE AND SKILLS:

• Working knowledge of billing requirements for assigned payers.
• Ability to systematically analyze problems, draw relevant conclusions and devise appropriate course of action.
• Ability to analyze data, perform multiple tasks and work independently.
• Good interpersonal skills in written and verbal form are required.
• Must be able to develop and maintain professional, service-oriented working relationships with senior leadership, patients, physicians, co-workers and employees.
• Ability to work in a fast paced environment, with focus on team building and productivity.

System Experience:

• Siemens (Invision) Preferred
• GE/IDX Preferred
• Huron-Trac/Quic Preferred
• Epremis Preferred
• Microsoft Outlook Required
• Microsoft Word Required
• Microsoft Excel Required
• FSS (Medicare Billing) Preferred
• Care Medic (Medicare Billing) Preferred
• NDC (Inpatient & Outpatient Billing) Preferred
• PC Print (Medicare EOB print) Preferred
• CMS (Commercial EOB print) Preferred

EDUCATION:

• Level of knowledge generally obtained through completion of High School.

EXPERIENCE:

• Minimum of two years of experience in an automated medical billing and collection environment for a medical services provider and/or third party payor. A high school diploma or GED completion is required.
• A comprehensive working knowledge of the application of Commercial, Workers Compensation and other third party payor rules, regulations, guidelines and requirements for billing, collection and reimbursement appeals. A basic understanding of how these regulations are applied to Massachusetts providers is desirable.
• Ability to learn PC based computer systems, word processing, database and spreadsheet software programs.
• Proficient in using computers and navigated through Blue Shield, Medicare and Medicaid and other third party computer/electronic application systems efficiently and effectively.
• Good interpersonal and communication skills and a basic understanding of team management concepts.
• Completion of a medical terminology course and understanding of CPT and ICD diagnosis coding preferred.
• Billing and accounts receivable software knowledge desired.

WORKING CONDITIONS/PHYSICAL DEMANDS:

• Works in a normal office environment with little discomfort due to dust, dirt and the like.
• Possibility of eyestrain due to use of computer.
• Frequent contact with interdepartmental employees.

All your information will be kept confidential according to EEO guidelines.

AMERICANS WITH DISABILITIES STATEMENT:

Must be able to perform all essential functions of this position with reasonable accommodation if disabled.

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed, as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. Tufts Medical Center reserves the right to modify position duties at any time, to reflect process improvements and business necessity.

COVID-19 POLICY:

Please note that effective October 1, 2021, as a condition of employment at Tufts Medical Center, all employees and new hires must have received their complete dose of the COVID-19 vaccine, unless they have been granted an exemption.