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PRE-BILLING & CLAIMS ASSOCIATE I

Company: UMass Memorial Health Care
Location: Worcester
Posted on: December 8, 2018

Job Description:

Requisition #: 190625

Title: Pre Billing and Claims Associate I

Department: Hospital Billing Pre-Billing & Claims

Grade: ADM5

Posting Date: November 19, 2018

Status: Non-Exempt

Shift: Days

Union: SHARE

Hours: 40

Shift Length: 8 hours

Location: UMass Memorial Health Care - 306 Belmont St, Worcester, MA

UMass Memorial Health Care is the largest health care system in Central Massachusetts. We are the clinical partner of UMass Medical School, with access to the latest technology, research and clinical trials. Our health care system includes four hospitals:


  • UMass Memorial Medical Center (Worcester)
  • UMass Memorial HealthAlliance-Clinton Hospital (Clinton, Fitchburg and Leominster)
  • Marlborough Hospital (Marlborough)

    In addition to our fully equipped medical centers, our system also includes home health and hospice programs, behavioral health programs and community-based physician practices.

    Position Summary:

    Supports the timely and accurate submission of claims using provided reference material to resolve claim edits supporting timely claim submission.

    Position Qualifications:

    A minimum of a High School diploma required. Minimum of 1 or more years of experience in health care billing functions. Knowledge and experience with health care revenue cycle systems and billing tools. Understanding of health care claim submission processes.

    Ability to perform assigned tasks efficiently and in timely manner. Ability to work collaboratively and effectively with people. Exceptional communication and interpersonal skills.

    Major Responsibilities:

    Prioritizes standards and guidelines to perform pre-billing and claims submission processes utilizing assigned work queues.

    Sorts, distributes and processes primary and secondary paper claims. Ensures appropriate attachments are included leveraging available technology if possible. Documents action taken as appropriate in the Hospital Billing revenue cycle management system.

    Submits electronic claims using the claims submission system in accordance with payer requirements.

    Resolves edits in the claim submission application.

    Uses provided reference material to troubleshoot edits and gain additional understanding of payer claim submission requirements.

    References payer websites as needed to acquire knowledge and understanding of appropriate follow up actions.

    Communicates and works with other team members collaboratively to understand and resolve claim edits and issues.

    Escalates trends and additional edits internally, to promote claim accuracy and quality applicable to Hospital Billing Revenue Cycle management system, claim submission system, and payor claims processing systems.

    Utilizes payer websites to identify claim submission requirements and communicate accordingly.

    Works specialty claims according to instruction and work with departments to resolve issues on a timely basis.

    Meets established productivity standards.

    Facilitates and promotes the sharing of knowledge and content throughout departments.

    Participates in cross training to optimize billing resources.

    Demonstrates excellent attendance and actively participates in a variety of meetings and training sessions as required.

    Maintains and fosters an organized, clean, and safe work environment.

    Maintains a collaborative, team relationship with peers and colleagues in order to effectively contribute to the group's achievement of goals and to help foster a positive work environment.

    Practices cost containment and fiscal responsibility through the efficient use of supplies, equipment, time, etc.

    Complies with established departmental policies, procedures and objectives.

    Attends variety of meetings, conferences, seminars as required or directed.

    Demonstrates use of Quality Improvement in daily operations.

    Complies with all health and safety regulations and requirements.

    Respects diverse views and approaches, and contributes in maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.

    Performs a variety of related duties as assigned by management.

    All responsibilities are essential job functions unless noted otherwise.

    Keywords: UMass Memorial Health Care, Worcester , PRE-BILLING & CLAIMS ASSOCIATE I, Accounting, Auditing , Worcester, Massachusetts

    Click here to apply!

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