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Exemption Status:

Non-Exempt

Schedule Details:

Monday through Friday

Scheduled Hours:

8-4:30

Shift:

1 - Day Shift, 8 Hours (United States of America)

Hours:

40

Cost Center:

99940 - 5418 Pre Billing and Claims

Union:

SHARE (State Healthcare and Research Employees)

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

Everyone Is a Caregiver

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 16,000 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.

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

I. Major Responsibilities:

1.  Prioritizes standards and guidelines to perform pre-billing and claims submission processes utilizing assigned work queues.
2.  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.
3.  Submits electronic claims using the claims submission system in accordance with payer requirements. 
4.  Resolves edits in the claim submission application. 
5.  Uses provided reference material to troubleshoot edits and gain additional understanding of payer claim submission requirements.
6.  References payer websites as needed to acquire knowledge and understanding of appropriate follow up actions.
7.  Communicates and works with other team members   collaboratively to understand and resolve claim edits and issues.
8.  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.
9.  Utilizes payer websites to identify claim submission requirements and communicate accordingly. 
10. Works specialty claims according to instruction and work with departments to resolve issues on a timely basis.
11. Meets established productivity standards.
12. Facilitates and promotes the sharing of knowledge and content throughout departments.
13. Participates in cross training to optimize billing resources.
14. Maintains and fosters an organized, clean, and safe work environment.
15. Maintains a collaborative, team relationship with peers and colleagues in order to effectively contribute to the group’s achievement of goals and to help foster a positive work environment.
16. Practices cost containment and fiscal responsibility through the efficient use of supplies, equipment, time, etc.

Standard Staffing Level Responsibilities:

1. Complies with established departmental policies, procedures and objectives.
2. Attends variety of meetings, conferences, seminars as required or directed.
3. Demonstrates use of Quality Improvement in daily operations.
4. Complies with all health and safety regulations and requirements.
5. Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.
6. Maintains, regular, reliable, and predictable attendance.
7. Performs other similar and related duties as required or directed.

All responsibilities are essential job functions.

II. Position Qualifications:

License/Certification/Education:
Required:
1. High School diploma
Experience/Skills:
Required:
1. Previous Revenue Cycle knowledge in one of the following areas including PFS, Customer Service, Cash Posting, Financial Assistance, Patient Access, HIM/Coding and/or 3rd party Reimbursement.
2. Ability to perform assigned tasks effici