Patient Financial Services Senior Specialist - Hospital Billing

Patient Financial Services Senior Specialist - Hospital Billing

Join to apply for the Patient Financial Services Senior Specialist - Hospital Billing role at Beth Israel Lahey Health

When you join the growing BILH team, you’re not just taking a job, you’re making a difference in people’s lives. Under oversight of the Department Manager, the Senior Specialist Patient Financial Services – Hospital Billing will be responsible for the efficient and accurate completion of senior level Accounts Receivable tasks. The Senior Specialist will handle the highest complexity for a large multi‑facility healthcare system, ensuring compliance and successful billing and collection within various work queues. The role serves as a mentor to staff throughout the Hospital Billing Revenue Cycle Teams, emphasizing departmental policies and procedures.

Job Description

Essential Duties & Responsibilities including but not limited to

• Utilizes the Epic Hospital Billing System to review and monitor accounts through the Billing, Denial, & Follow‑Up work queues
• Investigate and resolve assigned accounts of the highest level of complexity (i.e., inpatient, high dollar, aged accounts, etc.) within Hospital Billing, Denial, & Follow‑Up queues to completion, communicating to the Manager within the designated time frame
• Contact insurance carriers or other responsible parties to determine what is needed for complete and accurate appeal documentation and follow through to payment posting
• Gather all necessary documentation needed to have claims reprocessed/adjudicated
• Inform and/or transfer problematic accounts and denial trends to management for escalation within 2 days of identification
• Document all actions taken within the EPIC account notes section and/or follow‑up/denial activities note sections
• Adhere to all Hospital Billing, Follow‑up, and Denial departmental policies and procedures/training documents
• Complete necessary training sessions required for the Hospital Billing system and demonstrate good working knowledge to resolve assigned accounts within Follow‑Up and Denial queues
• Perform Hospital Billing Revenue Cycle staff educational shadowing sessions pertaining to operational policy and procedure workflow adherence upon management request
• Document all inactive periods and make them available upon management’s request
• Resolve accounts with the highest level of complexity in any Claims Edit work queue and resubmit claims through the Epic Billing System
• Work assigned accounts with the highest level of complexity within claim edit work queue(s) daily and resubmit claims through the Epic billing system
• Handle external claim edits from Clearinghouse and resubmit claims through the Epic billing system
• Handle paper claims processing, ensuring proper documentation of accounts with the highest level of complexity
• Communicate all claim/data problems to the Manager within one (1) day of identifying the issue(s)
• Identify and research all incomplete or inaccurate information on claims, demonstrating proper handling and escalation as needed
• Handle payer 277 rejections on accounts with the highest level of complexity; resubmit through Epic Billing system or other means (e.g., email, fax, payer portal, certified mail) and provide trends to management for payer outreach and internal billing system updates to ensure timely filing and reimbursement

Minimum Qualifications

Education: High School Diploma / GED Required

Licensure, Certification & Registration: None Required

Experience: At least seven (7) years accounts receivable experience required

Skills, Knowledge & Abilities

• Demonstrates excellent attention to detail and prioritization of accounts
• Demonstrates strong working knowledge of Epic Hospital Billing Follow‑Up and Denial workflows, considered as Subject Matter Expert (SME) to the team
• Strong, clear oral and written communication skills
• Professional telephone & email etiquette
• Ability to interact with insurance carriers, patients, and co‑workers professionally and helpfully
• Excellent use of billing computer and PC skills
• High level of problem solving and decision making skills
• Ability to resolve account issues to completion and obtain appropriate payment
• Ability to work independently and efficiently

Preferred Qualifications & Skills

• Experience in Revenue Cycle Accounts Receivable
• Experience working with EPIC

Pay Range
$23.00 - $30.95

The pay range listed for this position is the base hourly wage range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, including seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law. Compensation may exceed the base hourly rate depending on shift differentials, call pay, premium pay, overtime pay, and other additional pay practices, as applicable to the position and in accordance with the law.

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment.

More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients’ lives. Your skill and compassion can make us even stronger.

Equal Opportunity Employer/Veterans/Disabled

Seniority level

• Mid‑Senior level

Employment type

• Full‑time

Job function

• Health Care Provider
• Hospitals and Health Care

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