Pre-Billing and Claims Associate II

Are you an internal caregiver, student, or contingent worker/agency worker at UMass Memorial Health? CLICK HERE to apply through your Workday account.

Exemption Status:

Schedule Details:

Scheduled Hours:

Shift:

Hours:

Cost Center:

Union:

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

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, identifies failed edit trends and takes action to resolve appropriately Identify, research and resolve claim edits using all available resources, including payer websites, internal resources, and other available expertise.

Major Responsibilities:

• Resolves Medicare COB issues requiring contact with patients and payers with continuous follow up until resolution. Research prior claims submitted, to ensure accurate compliant billing for all services Corrects and updates claim information in the Medicare FISS system requiring in depth knowledge of Medicare billing and compliance regulations.
• Correct and resubmit claims in Mass Health MMIS and other payer websites.
• Utilizing assigned work queues resolves claim edits for high dollar encounters. (>$100,000) recognizing potential complexity and need for rapid resolution.
• Ensure appropriate attachments are included when submitting claims, leveraging available technology if possible. Documents action taken as appropriate in the Hospital Billing revenue cycle management system.
• Submits electronic claims using the claims submission system, in accordance with payer requirements.
• Resolves edits in the claim submission application.
• Analyzes and researches failed claim edits and work with departments and payers to resolve the edit within established timeframes, policies and procedures. Uses reference material to troubleshoot edits and gain additional understanding.
• Identifies the need for external claim review by other departments to ensure claim content is correct. Appropriately adds indicators on account to track responses.
• Submits HSNO secondary claims ensuring primary claim payment adjudication information has been accurately entered onto the claim. May require analysis of primary payment to ensure appropriate adjudication information has been included.
• Resolves complex claim edits requiring in depth understanding of billing codes and the impact on reimbursement. (modifiers, revenue codes, value codes etc.)
• Communicates and works with other team members and other departments to understand and resolve claim edits and issues.
• Recognize and escalates trends and additional edits internally, to promote claim accuracy and quality applicable to Hospital Billing Revenue Cycle management system, claim submission system, and payer claims processing systems.

The duties and responsibilities stated are a general summary and not all inclusive.

Position Qualifications:

License/Certification/Education:

Required:

• High School diploma

Experience/Skills:

Required:

• 3 or more years of experience in acute health care billing environment
• Ability to perform assigned tasks efficiently and in timely manner.
• Ability to work collaboratively and effectively with people.
• Exceptional communication and interpersonal skills.
• Advanced knowledge of claim form content and claim submission requirements. Understands and can explain the purpose of revenue codes, condition codes, occurrence codes, modifiers and value codes.
• Proactively proposes resolutions to issues. Ability to communicate verbally and clearly document all actions taken during resolution process.
• Demonstrates ability to research claim issues. Can provide root cause of claim issue and identify next steps needed to resolve issue.
• Experience with high dollar- high complexity claim submissions, i.e. Long length of stay, coverage changes and lapse, coordination of benefit issues. Ability to navigate in Mass Health claims processing application and/or the Medicare claims processing application.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

We're striving to make respect a part of everything we do at UMass Memorial Health - for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.

As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.

If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at talentacquisition@umassmemorial.org. We will make every effort to respond to your request for disability assistance as soon as possible.