Hybrid Patient Billing and Collections Specialist

South Shore Health; United States; Hybrid; USD 31,000 - 44,000; Full time

Job summary

South Shore Health is seeking a Patient Financial Services Representative to ensure efficient and professional handling of the financial aspects of patient care, including Medicare collections and Epic Billing System use for claims submissions and follow-up. The role involves resolving denials, communicating with payers, and helping maintain accurate account documentation.

Hybrid or remote work options may be available after training, with typical hours Mon–Fri.

Qualifications

• High school diploma or equivalent preferred.
• Minimum 2 years hospital/physician billing experience.
• Knowledge of healthcare billing, insurance plans, codes, and reimbursement methodologies.
• Proficiency in data entry and basic computer skills, including Microsoft Office Suite.
• Strong organizational and multitasking skills; strong interpersonal and communication skills; strong analytical and independent decision making skills.
• Hybrid or remote work options may be available; schedule M-F 7:00 AM - 3:30 PM; Hybrid option after training.

Responsibilities

• Maintains up to date knowledge of all Federal, State and Insurance specific billing regulations, policies, procedures and code sets.
• Notify manager of any changes that would affect claim submission.
• Protect patient privacy and confidentiality in accordance with HIPAA regulations.
• Maintain compliance with federal, state, payer, and organizational billing regulations.
• Monitor payer policy updates and communicate changes that may impact billing, collections, denials, or reimbursement processes.
• Evaluates daily claim file using Claim Edit and Charge Review Work queues for submission of UB-04 and 1500 claim forms.
• Initiate claim corrections as defined payer regulation and hospital policy.
• Work external claim edits from Clearinghouse and resubmit claims through EPIC.
• Initiate collection of aged accounts receivable through Epic work queues while prioritizing accounts based on aging criteria.
• Unresolved and incomplete accounts require insurance company contact by phone, e-mail or designated web site to resolve outstanding balances.
• Collaborate with denial management staff for accounts that require clinical intervention for an appeal process.
• Collaborate with clinical departments, patient access and other departments as needed to resolve account issues.
• Generate technical appeals as needed for account resolution.
• Provide to manager a detail account history for any account that is considered uncollectable.
• Document all actions taken within the EPIC account notes section and/or follow up/denial activities note section. Documentation is required at least every 30 days for all accounts requiring follow-up.
• Escalates payer related issues to Provider Representative for resolution and participate in monthly meetings.
• Must maintain defined quality and productivity measures.
• Evaluate current processes, identify denial or payment trends and elevate to Management.
• Handle payer 277 rejections and resubmit through EPIC system.
• Reconcile account balances and ensure appropriate adjustments are applied according to established policies.
• Review credits work queues for resolution of overpayments and undistributed payments.
• Review credit balances in assigned work queues and request refunds or payer retraction as needed.
• Communicate with patients as needed for additional insurance or other information needed in order to process a claim.
• Generate phone calls or letters as needed to obtain necessary insurance or other related information, prior to an account being placed in self pay.
• Obtain proper verification of predefined patient demographic information and maintain documentation in order to verify identity.
• Embraces technological solutions to work processes and practices.
• Uses the Mytime payroll system to enter time worked, sick days, vacations and holidays.
• Uses Epic functionality
• Uses MS Outlook as a communication tool
• Access provider web sites for verification of accounts.
• Access Sharepoint and OneDrive for stored files.
• Fosters a “Culture of Safety” through personal ownership and commitment to a safe environment.
• Successfully answers safety questions in the annual mandatory education packet.
• Maintains a neat, organized work environment.
• Adheres to respiratory etiquette guidelines.
• Assist with identifying workflow improvements to enhance operational efficiency.
• Assist leadership with special projects, audits, and process improvement initiatives.
• Other duties as assigned by Managements in accordance with department needs.

Education

High school graduate

Job description

South Shore Health is seeking a Patient Financial Services Representative to ensure efficient and professional handling of the financial aspects of patient care, including Medicare collections and Epic Billing System use for claims submissions and follow-up. The role involves resolving denials, communicating with payers, and helping maintain accurate account documentation.

Hybrid or remote work options may be available after training, with typical hours Mon–Fri.