Customer Billing II

Additional Location(s):  N/A

Diversity - Innovation - Caring - Global Collaboration - Winning Spirit - High Performance

At Boston Scientific, we’ll give you the opportunity to harness all that’s within you by working in teams of diverse and high-performing employees, tackling some of the most important health industry challenges. With access to the latest tools, information and training, we’ll help you in advancing your skills and career. Here, you’ll be supported in progressing – whatever your ambitions.       

About the role: 
Account Resolution Specialist is a position within our Houston Based Boston Scientific Cardiac Diagnostic revenue cycle team that works with insurance and patients regarding their cardiac diagnostic services claims. This position is responsible for reviewing and collecting denied insurance claims. Additionally, this position assists in problem solving, fact finding and assisting patients through complicated insurance processes. If you love working with people, patient satisfaction and problem solving this is a great opportunity to join the Boston Scientific Corporation team with opportunities to grow your career within a great company. At Boston Scientific, we value collaboration and synergy. This role allows a hybrid work model, requiring employees to be in our local office at least three days per week. Relocation assistance is not available for this position at this time. Boston Scientific will not offer sponsorship or take over sponsorship of an employment VISA for this position at this time.

 

Your responsibilities will include:

• Maintaining assignment of accounts receivable for area of expertise. This includes following up on accounts through the revenue cycle department, from charge review, claim edits, claim submission, and follow up with third party payers and patients to facilitate prompt resolution of outstanding account balances. 
• Interpret EOB including allowed amounts, discounts, in/out-of-network benefit levels, deductibles, co-insurances and copays.
• Apply ICD 10 and CPT code knowledge when reviewing accounts for collections.
• Follow-up on aging accounts receivable insurance claims and appeals. 
• Resolve claim edits via work queues and/or our external billing software.
• Compile and file all information needed to appeal denials.
• Follow federal and state regulations to ensure compliance standards are met.
• Monitor timely filing requirements on claims and appeals.
• Evaluate third party payments to ensure accuracy relative to contract language (underpayment/overpayment).
• Accurately document all actions taken to reconcile outstanding balances.
• Communicate with Revenue Cycle teams, payors and others to resolve account problems.
• Participate in meetings as needed to address any potential payor concerns.
• Review and validate adjustments to accounts in the queue based on insurance reimbursement, coverage, contracts and services provided.
• Complete work on special projects, queries and reports as assigned.
• Answer calls regarding insurance claims and patient benefits.
• Meet defined department goals and activity metrics. 
• Support co-workers and engage in positive interactions.
• Communicate professionally and timely with internal and external customers.
• Provide helpful assistance in anticipating and responding to the needs of our clients.
• Collaborate with customers in planning and decision making to result in optimal solutions.
• Ability to stay calm under pressure and deal effectively with difficult people.

 

Required qualifications:

• High School Diploma or equivalent combination of education/work experience.
• Sitting for extended periods of time will be required.
• Use of hands repetitively to type, handle, and operate standard office equipment will be required.

Preferred qualifications:

• Three years of experience in a healthcare revenue cycle, specific to area of 
• Expertise.
• Xifin Billing System Experience.
• Knowledge of claims processing and adjustments.
• Knowledge of Medicare, Medicaid, and Commercial carriers.
• Excellent communication and organizational skills.
• Ability to calculate insurance benefits and write appeal letters (using templates).
• Ability to read and understand Explanation of Benefits.
• Insurance verification and basic benefit coordination.
• Knowledge of Medicaid or Medicare Claim Processing regulations. 
• Proficient on Microsoft Word, Excel, Outlook, Internet Explorer.
• Ability to work in a collaborative, team environment.
• Ability to work independently and be result driven oriented. 
• Ability to be well organized, de