Lahey Health Shared Services is part of a vibrant and growing health care system, recognized as a trailblazer in medicine and a standard bearer in patient experience. It includes an award-winning academic medical center, a superb constellation of community hospitals, home care services, rehabilitation facilities and more.
We are committed to attracting, developing and retaining top talent in a market long recognized and revered as a global leader in health. With a team approach to care, we encourage learning and growth at all levels, and we offer competitive salaries and benefits. We adhere to the principles of a just and fair work environment for all colleagues, where respect is foundational and performance is rewarded.
About the Job
- Provides review and/or coding of any coding related denied professional services for appropriate use of CPT, ICD-9, ICD-10, HCPCS, Modifier usage/linkage.
- Periodic review of codes, at least annually or as introduced or required.
- Reviews and analyzes rejected claims and patient inquiries of professional services, and recommends appropriate coding corrections via paper or electronic submission to the Follow up Team.
- Reports coding trends and issues to the coding supervisor for education within the coding department and/or physician education.
- Confers regularly with the Coding Department through regular departmental staff meetings, on-on-one meetings to review and discuss coding denials and education.
- Maintains certification requirements for coding.
Follow Up Responsibilities:
- Monitors days in A/R and ensures that they are maintained at the levels expected by management. Analyzes work queues and other system reports and identifies denial/non-payment trends and reports them to the Billing Supervisor.
- Responds to incoming insurance/office calls with professionalism and helps to resolve callers’ issues, retrieving critical information that impacts the resolution of current or potential future claims.
- Establishes relationships and maintains open communication with third party payor representatives in order to resolve claims issues.
- Reviews claim forms for the accuracy of procedures, diagnoses, demographic and insurance information, as well as all other fields on the CMS 1500.
- Reviews and corrects all claims/charge denials and edits that are communicated via Epic, Explanation of Benefits (EOB), direct correspondence from the insurance carrier or others and uses information learned to educate PFS and office staff to reduce future denials and edits of the same nature. Initiates claim rebilling or corrections and obtains and submits information necessary to ensure account resolution/payments.
- Identifies invalid account information (i.e.: coverage, demographics, etc.) and resolves issues.
- Evaluates delinquent third party accounts and processes based on established protocols for review, payment plan or write-off.
- Reviews/updates all accounts for write-offs and refunds.
- Keeps informed of all federal, state, and managed care contract regulations, maintains working knowledge of billing mechanics in order to properly ascertain patients’ portion due.
- Completes all assignments per the turnaround standards. Reports unfinished assignments to the Billing Supervisor.
- Handles incoming department mail as assigned.
- Attends meetings and serves on committees as requested.
- Maintains appropriate audit results or achieves exemplary audit results. Meet productivity standards or consistently exceeds productivity standards.
- Provides and promotes ideas geared toward process improvements within the Central Billing Office.
- Assists the Billing Supervisor with the resolution of complex claims issues, denials and appeals.
- Completes projects and research as assigned.
- Provides feedback and participates as the coding representative for the Patient Financial Services Department on the Revenue Cycle teams.
- Enhances professional growth and development through in-service meetings, education programs, conferences, etc.
- Complies with policies and procedures as they relate to the job. Ensures confidentiality of patient, budget, legal and company matters.
- Exercises care in the operation and use of equipment and reference materials. Performs routine cleaning and preventive maintenance to ensure continued functioning of equipment. Maintains work area in a clean and organized manner.
- Refers complex or sensitive issues to the attention of the Billing Supervisor to ensure corrective measures are taken in a timely fashion.
- Observes irregularities in the cash/denial posting process and reports them immediately to the Billing Supervisor.
- Accepts and learns new tasks as required and demonstrates a willingness to work where needed.
- Assists other staff as required in the completion of daily tasks or special projects to support the department’s efficiency.
- Performs similar or related duties as assigned or directed.
Education & Professional Development
- Researches and stays updated and current on CMS (HCFA), AMA and Local Coverage Determinations (LCD’s), or Local Medical Review Policies (LMRP's) to ensure compliance with coding guidelines.
- Stays current on quarterly CCI Edits, bi-monthly Medicare Bulletins, Medicare's yearly fee schedule, Medicare Website, and specialty newsletters.
- Makes guidelines available via, paper, on-line access, web access, or any other means provided by manager.
- High School diploma or equivalent, plus additional specialized training associated attainment of a recognized Coding Certificate
Licensure, Certification & Registration
- CPC (Certified Professional Coder through AAPC) or CCS-P (Certified Coding Specialist Physician Based through AHIMA)
- 1-2 years of experience in billing, coding, denial management environment related field.
Skills, Knowledge & Abilities:
- Ability to work with frequent interruptions and respond appropriately to unexpected situations. Good judgment and problem solving skills
- Ability to work independently and take initiative
- Excellent organizational skills
- Ability to interact and collaborate effectively and tactfully with staff, peers and management.
- Ability to promote team work through support and communication.
- Ability to accept constructive feedback and initiate appropriate actions to correct situations.
Lahey Health Shared Services (LHSS) provides unified and streamlined administrative and operational services and support to all members of the Lahey Health system.
Through use of best practices, LHSS achieves greater efficiency and effectiveness across Lahey Health, helping create the most effective organization possible, for both our patients and our employees. LHSS is dedicated to leveraging resources across the organization to ensure high-quality, high-value care to the people and communities we care for so proudly.