• P_Billing Specialist (Athena Collector)

    Location US-MA-Brookline
    Job Posted Date 3 weeks ago(3/28/2018 8:24 AM)
    Job ID
    2018-10245
    Category
    DFCCC
    Type
    full time
    Grade
    17
  • Overview

    Located in Boston and the surrounding communities, Dana-Farber Cancer Institute brings together world renowned clinicians, innovative researchers and dedicated professionals, allies in the common mission of conquering cancer, HIV/AIDS and related diseases. Combining extremely talented people with the best technologies in a genuinely positive environment, we provide compassionate and comprehensive care to patients of all ages; we conduct research that advances treatment; we educate tomorrow's physician/researchers; we reach out to underserved members of our community; and we work with amazing partners, including other Harvard Medical School-affiliated hospitals.

     

    The Billing Specialist reports to the Billing Manager and is responsible for billing and claims resolution for Dana-Farber Community Cancer Care patients, private insurance companies, Medicaid and Medicare. He/she must effectively interact with multiple disciplines including management, financial clearance staff, nursing staff, physicians, commercial insurance carriers and government agencies. He or she must demonstrate self-direction, professionalism, effective communication skills, the ability to work in a team environment, a high-level expertise in understanding commercial and governmental insurance carrier rules and regulations, and the ability to manage ongoing change and think creatively.

    Responsibilities

    • Corrects procedure and diagnosis coding on claims held by claim scrubber. Confirms diagnosis and procedures with nurses and physicians to ensure information is correct; adds correct modifiers as needed.
    • Verifies that procedure charges are consistent with insurance guidelines to minimize claim denial.
    • Attaches patient co-payment and any unpaid balance money received that could not be done automatically by practice management system.
    • Responsible for monitoring open encounter list to ensure all encounters received are entered.
    • Prepares and submits insurance claims.
    • Sends all insurance verification denials to financial clearance team.
    • Identifies liability and guarantors; reviews and adjusts account balances.
    • Facilitates the interpretation of Explanation of Benefits (EOBs) and follows up as needed.
    • Posts payments and adjustments not automatically processed by the practice management system; validates payments and adjustments automatically processed by practice management system.
    • Works with athenaHealth employees to resolve claim issues identified via worklists.
    • Assists in the collection of past due accounts by following up with insurance companies to learn the status of claims after initial athenaHealth follow-up. Also submits appeals on denied claims as required after initial athenaHealth follow-up.
    • Maintains current knowledge of all CPT code changes and billing requirements.
    • Attends billing meetings and training courses requested by Billing Manager.
    • Maintains HIPAA compliance.
    • Other duties as required.

    Knowledge, Skills and Required Abilities

    • Knowledge of medical procedures, CPT codes, ICD-10 coding.
    • Knowledge of insurance company operating procedures and requirements for billing.
    • Must have the ability to maintain confidentiality of patient information and office information.
    • Must have the ability to recognize, evaluate, and correct errors.
    • Must have the ability to work with other billing office employees / vendors to obtain necessary information.  
    • Must possess exceptional communication (verbal) skills.
    • Must have skills and knowledge of computer, hardware and software. Must have the capability of working well independently as well as under direct supervision.
    • Knowledge of athenaCollector is a plus.
    • Must have experience working with HCFA 1500s and Medicaid form 5.
    • Must have experience working with Medicaid, Medicare and Commercial Insurance.

    Qualifications

    High school diploma and 2 years of physician office billing experience are required.


    Dana-Farber Cancer Institute is an equal opportunity employer and affirms the right of every qualified applicant to receive consideration for employment without regard to race, color, religion, sex, gender identity or expression, national origin, sexual orientation, genetic information, disability, age, ancestry, military service, protected veteran status, or other groups as protected by law.

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