Billing Representative Iii

2 weeks ago

Boston, United States Massachusetts General Hospital(MGH) Full time

**Billing Representative III**
- (3290068)

GENERAL SUMMARY/ OVERVIEW STATEMENT: Summarize the nature and level of work performed. Please note that this section should be written in a paragraph format and provide a broad description of the role and its purpose as well as the reporting structure.

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: In order of importance, list essential areas of responsibility, major job duties, special projects and key objectives for this position. These items should be evaluated throughout the year and included in the written annual evaluation. This section should be completed as a bulleted list and explain how the role is performed.
- 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.
- Serve as the primary backup to the Billing Representative II.

**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 mínimal direct supervision. Act with mínimal 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.
- 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_._
- 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:
1. Insurance verification and eligib

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