Patient Financial Services Specialist (Hospital Billing) Remote Facility : Beth Israel Lahey He[...]

Job OverviewJob Type: Regular Full Time. Work Shift: Day. Location: Remote (United States of America). FLSA Status: Non-Exempt. This Patient Financial Services Specialist – Hospital Billing will be responsible for efficient and timely billing and collections of hospital outstanding balances on inpatient and outpatient accounts receivable that are of higher complexity within assigned work queues for a large multi‑facility healthcare system. Essential ResponsibilitiesUtilizes the Epic Hospital Billing System to review and monitor accounts through the Billing, Denial, & Follow‑Up work queues. Works assigned accounts with higher complexity (high dollars, specific denial records, etc.) while maintaining established productivity requirements. Contacts insurance carriers or other responsible parties to confirm payment dates, question claim denials, or investigate failure to process a claim. Performs all Hospital Billing, Follow‑Up, and Denial activities necessary to obtain payment or resolve claims. Reviews the entire account to ensure claims were billed properly, payments were applied correctly, and necessary adjustments were made before moving the account to the next responsible party or removing it from the work queue. Gathers all necessary documentation needed to reprocess or adjudicate claims. Informs or transfers management of any problem accounts or denial trends that require escalation within two days of identification. Documents all actions taken within the EPIC account notes section and/or follow‑up / denial activity notes. Adheres to all Hospital Billing, Follow‑Up, and Denial departmental policies and procedures. Completes required training sessions and demonstrates working knowledge sufficient to resolve assigned accounts within Follow‑Up and Denial work queues. Documents all inactive periods and makes them available upon management’s request. Resolves higher‑complexity accounts in any Claims Edit work queue and resubmits claims through the Epic Billing System. Works higher‑level complexity external claim edits from the Clearinghouse and resubmits claims through the Epic billing system. Handles paper claim processing, including proper documentation of accounts with higher complexity. Communicates all claim or data problems that cannot be handled to the Supervisor or Manager within one day of identification. Identifies and researches all incomplete or inaccurate information on claims, demonstrating proper handling and escalation as needed. Handles payer 277 rejections on higher‑complexity accounts and resubmits claims through Epic Billing system or other submission methods (email, fax, payer portal, certified mail), providing trends to management for payer outreach or internal billing system updates to ensure timely filing and reimbursement. Skills, Knowledge & AbilitiesExcellent attention to detail and prioritization of accounts. Strong working knowledge of Epic Hospital Billing Follow‑Up and Denial workflows; acts as a subject matter expert to the team and colleagues. Clear oral and written communication. Professional telephone and email etiquette. Ability to interact with insurance carriers, patients, and co‑workers in a professional and helpful manner. Advanced 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. Capacity to work independently and efficiently. Preferred Qualifications & SkillsExperience in Revenue Cycle Accounts Receivable. Experience working with EPIC. At least five (5) years of accounts receivable experience. EducationHigh School Diploma / GED Required. Other RequirementsAll staff are required to be vaccinated against influenza (flu) as a condition of employment. EEO StatementEqual Opportunity Employer / Veterans / Disabled.#J-18808-Ljbffr