Billing Representative III

GENERAL SUMMARY/ OVERVIEW STATEMENT:

Reporting directly to the Practice Manager and under the general direction of the Senior Administrative Manager is able to perform a wide spectrum of billing functions to minimize accounts receivable, enhance collection performance. This position is relied upon to train staff and work on any activity within the team with little supervision. Utilizes electronic billing and medical retrieval systems as well as in depth knowledge of medical billing and insurance rules and regulations to resolve accounts receivable issues. This position serves as the primary resource for the Practice Manager on complex issues and specified duties.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

* Achieve excellence in performance by working collaboratively with others on MGH, MGPO and departmental billing and coding initiatives.
* Supports and demonstrates the values of the Massachusetts General Hospital by conducting activities in an ethical manner with integrity, honesty, and confidentiality. Demonstrates a positive, open-minded, can-do attitude. Represents a team perspective and willingness and enthusiasm to collaborate with others. Follows through on commitments and achieves desired results. Exhibits sound judgment, obtains the facts, examines options, gains support, and achieves positive outcomes.
* Maintain high standards of professional conduct at all times.
* Enthusiastically promote a cooperative team environment to provide value to all customers. Act as a leader in creating a positive atmosphere within the team. Listen and interact tactfully, diplomatically and effectively without alienating others.
* Develop relationships with management in order to modify/create procedures aimed at reducing backlogs and improve financial performance.

Account Management

* Perform all aspects of the Representative II position at a consistently high degree of proficiency. This entails a complete understanding of all department policies and procedures to execute all billing tasks with minimal direct supervision. Act with minimal supervision, notice or direction to identify and resolve problems and complete work. This representative is expected to be a leader within the team in productivity, teamwork, efficiency, communication and the overall patient experience.
* Train and orient staff at the direction of the Practice Manager as needed. Includes maintaining and updating documentation for workflows and work files.
* Function as the 'go to' person within the Team for payer and/or specialty specific questions or issues.
* Ability to work the most sensitive and/or high profile patient accounts, projects and/or accounts as directed. Provide immediate feedback to Practice Manager on changes or modification that need to be communicated to appropriate teams within MGH Dental Group Practice.
* Apply expert knowledge of insurance rules and regulations to interpret new insurance/HCFA/HIPAA information and report potential impact. Utilize experience and expertise to efficiently and effectively determine the correct course of action on each account/project.
* Effectively handle telephone inquiries from all customers including patients, insurance companies and PBO group. Gather and interpret all relevant information to help resolve issues or complaints. Document issues thoroughly.
* Represent the department in meetings with PBO or MGH staff as well as with Insurance Representatives. Assist Practice Manager with facilitating team meetings and documenting minutes as needed.
* Coordinate data to complete special billing projects based on contractual obligations and regulatory demands.
* Apply transfers and/or adjustments to invoices as necessary to complete the resolution of each invoice.
* Request necessary follow-up data via manager as appropriate to resolve issues and trends once identified within their workflows and follow through on resolutions to completion.
* ]Provide detailed summaries of issues/requests with supportive data to management. Recommend resolutions, workflows, and identify root cause. Must be able to exercise proper judgment as necessary and raise issues to the appropriate management level.
* Provide opportunities for continuing education, skill training and upward mobility for employees. Create an environment that encourages quality, productivity, loyalty, job satisfaction and positive reinforcement.
* Ensure that quality services are delivered to the customer. Ensure that adequate monitoring plans are in place with appropriate reward and corrective action systems.
* Meet deadlines and exceed both productivity and quality standards for Epic Workqueues, including but not limited to:
* Insurance verification and eligibility
* Referral Management
* Submission of Prior Authorizations
* Correspondence & phone inquiries
* Billing/mailing claims/appeals
* Providing pre-estimates to patients
* Working on claim edits provided by MGPO billing team
* Reconciling refunds between Eaglesoft and Epic
* Third party follow-up including secondary billing & rejections
* Submit cash/check deposits to MGH
* Special projects


* Schedule prep- preparing patient estimates and presenting to patient
* Working with PBO department to resolve claims
* Aiding PBO department with dental billing
* Researching information on spread sheets from the PBO
* Asst. with correct ADA codes to bill, in line with treatment preformed.
* Coordinating with other department within MGH or outside for payments for dental work preformed
* Appling for PA'S required by insurance company and pre estimates.
* Scheduling appointments
* Working with patients to resolve issues
* Orthodontic collects/Dental collections / taking payments
* Help other staff with problem solving
* Finding billing and payment errors
* Find missing procedures not billed by provider
* Demonstrate proficiency with a variety of automations, including but not limited to Epic, Microsoft Word, Excel, E-mail, Voice-mail and Payor Websites.
* \Take a lead role in continuous quality improvement efforts on an ongoing basis. Establish goals with Practice Manager and track progress. Comply with hospital confidentiality policy. Manage special projects as assigned.
* Effectively handle complaint and complex calls from patients by defusing the situation and resolving the relevant issues when providing assistance to Customer Service & Self-pay. Utilize collections experience and expertise to efficiently and effectively determine the correct course of action on each account/project.
* Perform other duties as assigned

SKILLS & COMPETENCIES REQUIRED:

* High School Diploma Required. College Education Preferred.
* Excellence in customer service skills
* Effective communication and interpersonal skills to successfully interact with internal and external customers
* Effective organizational and problem solving skills
* Strong analytical skills
* Ability to manage multiple tasks/projects simultaneously
* Must be able to act with minimal supervision, notice or direction to complete work and identify/resolve problems by utilizing billing knowledge and experience. Must be independent.
* Demonstrated proficiency with a variety of automations, including but not limited to Epic, Microsoft Word, Excel, Email and electronic data processing skills
* Must be able to demonstrate expert knowledge of key processes while demonstrating a complete understanding of where each job within Patient Financial Services fits into the overall mission of the organization.
* Established as a dynamic and positive team player, able to work independently and in a group/team setting
* Detail oriented
* Must be able to develop training curriculum and conduct training sessions as needed
* Adapt positively to changes in the work setting with ease

Working Conditions:

Fully remote

In person for all staff meetings, billing meetings and front desk meetings.