Payment Verification Specialist job – Tufts Medical Center – Boston, MA

Req Number: 10117603 Department:: Physicians Organization Schedule: Full-Time Regular Shift: Day shift Grade: 08 Hours: 8-430p Job Details: 3-5 years experience is required Under general supervision this position is responsible for reviewing accounts identified and assigned to the Under/Over Payment Analyst including verification, billing, analysis, follow-up, denial and appeal processing, and account closure for assigned third party payers. This position performs a wide variety of billing, identifying over and under payments for follow up and resolution. Typical duties will include activities related to the hospital and professional billing services, to include development and oversight of Department: initiative related to identified under/over payment of hospital & professional reimbursement. Incumbent will work with systems support, vendors and contracting support to maintain adequate data and reporting to identify and analyze trends.

Responsible for monitoring all payer contracts loaded in the billing systems and work with internal support, system vendors and payer reps to ensure appropriate reimbursement. Responsibilities: Conducts follow-up of outstanding account balances with assigned payers and takes action for resolution. Completes appeal letters to collect appropriate reimbursement according to payer contract. Responsible for the processing of adjustments due to denials, contractual requirements, and credit balances.

Generates analytical reports for management to review activity of rebills, status of underpaid/overpaid accounts, recoupment amounts and identify payment discrepancy trends. Resolves assigned accounts in a timely and accurate manner, which maximizes reimbursement in compliance with assigned payer regulations and Department: ‘s policy and procedure. Maintains knowledge of federal/State documentation and payer requirements along with annual updates to CPT/ICD-9 coding guidelines. Regular interaction with other Department: s of the hospital to resolve accounts, including Medical Records, HIM, internal staff members, Utilization Review and Preadmission office.

Interacts on a daily basis over the phone and through correspondence with assigned payers. Establishes working relationships with payer representatives to facilitate processing Tufts MC accounts. Interacts with our vendor reps to update on findings of incorrect loading of variances based on the research with payers and provides feedback to make corrections and updates to avoid future erroneous variances. Consistently achieves and maintains performance standards for assigned productivity, collections, and quality targets.

Identifies trends in workflows and rework, and report outstanding operational issues to management for further research and resolution. Performs other similar and related duties as required or directed. Requirements: Working knowledge of billing requirements for assigned payers. Ability to systematically analyze problems, draw relevant conclusions and devise appropriate course of action.

Ability to analyze data, perform multiple tasks and work independently. Must be able to develop and maintain professional, service-oriented working relationships with senior leadership, patients, physicians, co-workers and employees. Ability to work in a fast paced environment, with focus on team building. System Experience: Siemens (Invision) Preferred GE/IDX Preferred Harvest Preferred Experian Preferred Microsoft Word Required Microsoft Excel Required Microsoft Powerpoint Preferred Microsoft Access Preferred Care Medic (Medicare Billing) Preferred NDC (Inpatient & Outpatient Billing) Preferred PC Print (Medicare EOB print) Preferred CMS (Commercial EOB print) Preferred Level of knowledge generally obtained through completion of some college background.

Work requires a minimum of 4 years of healthcare experience, with a focus on hospital billing and collections.

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