Claims Support Specialist-Physician Billing

The Physician Billing Claim Support Specialist is responsible for ensuring accurate and complete claim submissions for the Baystate Medical Practices. Utilizing multiple insurance edit reports and computer programs, this role updates claim elements to allow for effective and timely submission of claims.

Job Responsibilities:

1) Charge Corrections - Process all types of charge corrections including simple insurance changes, claims that have payments, claims that have co-payments or both.

2) Fatal Edits - Maintains all fatal edits on a weekly basis ensuring that claims are all processed within the allotted time line issued by each payer.

3) TES Edits - Maintains assigned TES edits to ensure timely filing of claims.

4) Appropriately submits claims either electronically or on paper.

5) Maintains current knowledge of web sites used in the process of insurance verification. This will include NEHEN and other direct web sites.

6) Updates patient accounts accurately including patient contact information and insurance information.

7) Current knowledge of third party billing requirements to ensure compliance with the highest standard of confidentiality and effectiveness.

8) Documents account with all information relevant to the timely submission and resolution of claims.

9) Interacts effectively with all units to maintain a smooth transition of information whenever necessary.

10) Maintain and submit detailed logs and production reports according to departmental guidelines.

Required Work Experience:

1) Advanced PC skills and ability to operate a variety of other necessary office equipment (ie calculator, copiers, fax machine, etc)

2) Knowledge of current third party billing guidelines and requirements

3) Minimum of three years third party billing experience

4) Strong typing/number pad skills to meet/exceed production expectations

5) Minimum typing speed of 35 words per minute

6) Knowledge of medical terminology

7) Knowledge of elementary accounting principles

Preferred Work Experience:

1) Advanced knowledge of Centricity (IDX) preferred

2) Hours are 7:30AM-4:00PM (with some flexibility)

Skills and Competencies:

1) Exceptional organizational and tracking skills

2) Good communication skills and the ability to effectively communicate with various levels of staff

3) Ability to manage complexities of payer adjudication of claims and coordination of benefits

4) Ability to work independently in a fast paced environment

5) Proficient in the English language along with grammar

6) Ability to maintain confidentiality of sensitive information

7) Ability to prioritize and organize

You Belong At Baystate

At Baystate Health we know that treating one another with dignity and equity is what elevates respect for our patients and staff. It makes us not just an organization, but also a community where you belong. It is how we advance the care and enhance the lives of all people.

DIVERSE TEAMS. DIVERSE PATIENTS. DIVERSE LOCATIONS.

Education:

GED or HiSET (Required)

Certifications:

Equal Employment Opportunity Employer

Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.

Ab out Baystate Health

Baystate Health (BH) is one of New England's leading and largest integrated health care organizations, serving a population of nearly one million people throughout western New England. With roots dating back to the founding of Springfield City Hospital in 1873, Baystate Health has been providing high-quality and compassionate health care in western Massachusetts for more than 145 years. With more than 12,000 employees, a medical staff of nearly 3,100 physicians, and a net patient service revenue of more than $1.4 billion, the ever-growing health system includes five Massachusetts hospitals and the Baystate Mary Lane Outpatient Center in Ware:

• Baystate Medical Center in Springfield

• Baystate Children's Hospital (located at Baystate Medical Center)

• Baystate Franklin Medical Center in Greenfield

• Baystate Wing Hospital in Palmer

• Baystate Noble Hospital in Westfield