Lead Pre-Billing&Claims Assoc

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Exemption Status:

Schedule Details:

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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.

I. Major Responsibilities:

1. Provides functional oversight to assigned employees.
2. Distributes and monitors workflow and responsibilities for employees in assigned area of oversight.
3. Monitors relevant employee performance metrics and reports to supervisor or manager.
4. Monitors department activity and metrics and troubleshoots coverage and/or volume issues. Provides recommendations to the manager or supervisor for the most efficient utilization of assigned personnel.
5. Work assigned work queues within established protocols. Works escalated accounts from staff, upper management, or other departments, and reports steps taken to resolve. Performs special projects as assigned by manager or supervisor.
6. Works specialty claims according to instruction and work with departments to resolve on a timely basis.
7. Works escalated accounts from staff, upper management, or other departments, and reports steps taken to resolve.
8. Provides training and technical assistance to assigned employees.
9. Assists supervisor or manager in assuring that assigned employees are provided with appropriate resources, materials and methods.
10. Communicates regularly with staff, including scheduling meetings, relaying work instructions from the supervisor and sharing important information and updates.
11. Assists in establishing and maintaining departmental policies and procedures.
12. Works with the Training and Quality Assurance department to train all assigned staff appropriately on specific job duties and new processes
13. Identifies performance improvement opportunities and works with relevant parties to develop solutions.
14. Performs special projects as assigned by manager or supervisor.
15. Sorts, distributes and processes primary and secondary paper and electronic claims using the relevant claims system in accordance with payer requirements.
16. Analyzes and researches failed claim edits and work with departments and payers to resolve within established timeframes, policies and procedures.
17. Communicates trends and additional edits internally to promote claim accuracy and quality.
18. Works with other departments to resolve claim edits.
19. Meets established productivity standards.
20. Facilitates and promotes the sharing of knowledge and content throughout departments.
21. Follows all established departmental policies and procedures.
22. Participates in cross training to optimize billing resources.
23. Demonstrates excellent attendance and actively participates in a variety of meetings and training sessions as required.
24. Maintains and fosters an organized, clean and safe work environment.
25. Contributes to the development and application of process improvements.
26. Maintains a collaborative, team relationship with peers and colleagues in order to effectively contribute to the group's achievement of goals and to help foster a positive work environment.
27. Practices cost containment and fiscal responsibility through the efficient use of supplies, equipment, time, etc.
28. Performs assigned tasks efficiently and in timely manner.
29. Ensures appropriate applications are updated timely and completely.

Standard Staffing Level Responsibilities:

1. Complies with established departmental policies, procedures and objectives.
2. Attends variety of meetings, conferences, seminars as required or directed.
3. Demonstrates use of Quality Improvement in daily operations.
4. Complies with all health and safety regulations and requirements.
5. Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.
6. Maintains, regular, reliable, and predictable attendance.
7. Performs other similar and related duties as required or directed.

All responsibilities are essential job functions.

II. Position Qualifications:

License/Certification/Education:
Required:
1. High School diploma

Experience/Skills:
Required:
1. Five or more years of experience in health care billing functions.
2. Knowledge and experience with health care revenue cycle systems and billing tools.
3. Understanding of health care claim submission processes.
4. Ability to work collaboratively and effectively with people.
5. Exceptional communication and interpersonal skills.
6. 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.
7. Experience with high dollar- high complexity denial resolution, ie Long length of stay, coverage changes and coverage lapse,
8. Ability to navigate in MassHealth claims processing application and/or the Medicare claims processing application.
9. Takes initiative to reach out to peers and assist in issue resolution

Unless certification, licensure or registration is required, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements.

Department-specific competencies and their measurements will be developed and maintained in the individual departments. The competencies will be maintained and attached to the departmental job description. Responsible managers will review competencies with position incumbents.

III. Physical Demands and Environmental Conditions:

Work is considered sedentary. Position requires work indoors in a normal office environment.

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.