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Exemption Status:

Non-Exempt

Hiring Range:

$22.29 - $36.69

Please note that the final offer may vary within this range based on a candidate’s experience, skills, qualifications, and internal equity considerations.

Schedule Details:

Scheduled Hours:

Shift:

1 - Day Shift, 8 Hours (United States of America)

Hours:

40

Cost Center:

99940 - 5438 Mental Health Pod Chg Cap Ar

Union:

SHARE (State Healthcare and Research Employees)

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

Everyone Is a Caregiver

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 20,000 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.

Provides functional oversight to staff. Performs follow-up of complex surgical/procedural/multidisciplinary specialty claims for payments, as well as auditing, coding and analyzing claims and claim payments/rejections.

I. Major Responsibilities: 

1. Monitors changes in reimbursement policies.
2. Establishes, monitors and maintains standards of quality, quantity, and functions performed by the staff. Audits staff quarterly or more frequently as determined by the audit policy and procedure. Ensures staff’s daily stats are completed and forwarded to supervisor weekly.
3. Audits, codes, and analyzes third party reimbursements for revenue enhancement.
4. Reviews complex rejections and appeals across complex surgical/procedural/multi-disciplinary specialties. When appropriate, creates and assists in composing detailed clinical appeals to second and third level reviews.
5. Performs special projects as assigned by manager or supervisor defining problems, determining work sequence and summarizing findings.

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 plus additional post-secondary courses in medical billing and medical terminology required.  

Experience/Skills:
Required:
1. Three years physician or medical billing experience involving complex surgical/procedural/multidisciplinary specialties required. 
2. Knowledge of multiple third-party insurance regulations, ICD, CPT and HCPCS coding and modifier assignment. 
3. Knowledge of medical terminology, anatomy & physiology and disease process.
4. Knowledge of billing and reimbursement practices/requirements of major third-party payors in Massachusetts.
5. Ability to organize and prioritize work to meet strict deadlines. 
6. Computer skills to include mainframe and PC applications as well as excel. 
7. Must be self-motivated, service oriented and have excellent communication skills (written and oral). 
8. Physician coding certification is desired.

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.