Join to apply for the 3rd Party Data/Billing Specialist role at Bay Cove Human Services
Bay Cove Human Services’ mission is to partner with people to overcome challenges and realize personal potential. Bay Cove pursues this mission by providing individualized and compassionate services to people facing the challenges associated with developmental disabilities, mental illness, substance use disorders, and homelessness at more than 175 program sites throughout Greater Boston and Southeastern Massachusetts.
Job Summary
Your position as Billing Specialist supports our mission by the administration of third party billing. This person will report to our Third Party Billing Manager. This is a non-exempt position.
Responsibilities
* Serve as contact person for assigned payer(s), establishing and maintaining relationships with contacts at the payer end to maximize revenue collection. Act as primary gateway for tracking changes in payers’ rules, regulations, and procedures. Communicate these changes to Billing Manager and program staff as necessary. Complete payer relations status report, including updates on all payer requirement changes, and submit to Billing Manager by the 28th of each month.
* Coordinate the submission of billing from assigned programs. Review billing data received from program staff. Evaluate and track its accuracy and completeness, requesting and monitoring corrections as necessary. Complete billing status report and submit to 3rd Party Billing Manager every Friday. Provide feedback to programs and Team Leader regarding any issues found during billing that may impact reimbursement (i.e., authorization or eligibility).
* Enter the correct, complete billing information into the A/R Plus System.
* Run A/R Plus problem report. Correct any problem claims on a weekly basis.
* Batch and submit clean claims in a timely manner to each of the assigned payers, consistent with Commonwealth of Massachusetts and Department of Public Health regulations. Obtain written or electronic confirmation of accepted files.
* Follow up with the payer to ensure the batch is received and processed within two weeks.
* Enter all denials for assigned billing into the A/R Plus System on a weekly basis, and immediately upon receipt from payers.
* Make follow-up calls to insurers regarding the status and collectability of unpaid or denied claims.
* Analyze and track denials for assigned programs and/or payers. Report on denial trends and progress toward collection of outstanding claims on a weekly basis.
* Complete rebilling of denied claims, pursuant to payer policies and regulations.
* Complete write-off request log and submit to 3rd Party Billing Manager weekly. Complete write-offs and billing adjustments for uncollectible claims as needed and approved by Team Leader.
* Prepare monthly reports, including but not limited to utilization, productivity, and write-offs.
* Assist Team Leader with preparation of other monthly and periodic reports as needed.
* Participate in special projects for appeals, rebilling, and corrective billing as necessary and within all designated timeframes for each project.
* Follow up with Team Leader regarding any other issues or problems discovered as part of the above activities.
* Maintain the confidentiality of client information according to HIPAA regulations.
* Comply with all department and agency policies and procedures.
* Complete special projects as necessary and other relevant duties as assigned.
Qualifications
* Minimum of two years of relevant third party billing experience (i.e., mental health, substance abuse, developmental disabilities, senior services)
* Proficiency in Hill A/R Plus or similar software required
* Proficiency in MS Excel and computer literacy; ability to learn new software quickly
* Highly developed organizational skills and ability to meet deadlines in a fast-paced work environment
* Demonstrated ability to work effectively and collaboratively with a diverse population of colleagues, program staff, and payers
* Demonstrated ability to work both independently and within a team
* Professional documentation and communication skills
* Ability to be flexible, open, and responsive to ongoing industry changes
* Ability to identify opportunities and obstacles and develop effective, creative responses to both problem-solving and the pursuit of new opportunities
* Commitment to excellence in job performance and willingness to follow through on all reasonable means to complete assigned functions in the most timely and accurate fashion possible
* Ability to attend meetings at various locations within and without Bay Cove
* An acceptable CORI (criminal record assessment)
Bay Cove Human Services is an Equal Opportunity Employer and does not discriminate on the basis of race, ethnicity, religion, sex, gender identity or expression, national origin, sexual orientation, disability, age, veteran status, or any other groups as protected by Massachusetts or federal law. All qualified candidates, regardless of background, are encouraged to apply.
Bay Cove Human Services does not offer visa sponsorships at this time and will require candidates to be authorized to work in the United States.
Seniority level
* Entry level
Employment type
* Full-time
Job function
* Information Technology
Industries
* Hospitals and Health Care
* Mental Health Care
* Non-profit Organizations
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