Revenue Cycle Business Partner I

This is a fully remote position, open to applicants in Massachusetts.

📋 Description

• Collect, analyze, and interpret data related to the revenue cycle to identify trends, patterns, and opportunities for process improvement.

• Create reports and dashboards that track key performance indicators (KPIs) for billing, collections, and reimbursements.

• Offer analytical insights and recommendations aimed at enhancing revenue cycle performance.

• Collaborate with vendors to address late charges, including late charge and late replacement claims with the appropriate Type of Bill.

• Engage in internal audits and quality assurance activities.

• Review, reconcile, and correct edits from the clearinghouse, particularly for complex accounts or payers.

• Communicate with insurance companies, government agencies, patients, and other stakeholders via phone, email, or correspondence to assist with claim submission and resubmission.

• Utilize insurance and third-party websites to acquire necessary information.

• Address inquiries regarding billing and payments.

• Log correspondence and conversations in patient accounts or phone logs.

• Review no-response work queues with third-party payer vendors to resolve outstanding claims.

• Investigate account histories, patient encounters, charts, charge and payment histories, account and claim status changes, and payer remittance advice.

• Examine underpaid claims and discrepancies in contracts; escalate issues related to Epic or legacy contract management.

• Assess account balances, resolve discrepancies, attach documentation, amend account data, gather information, and resubmit corrected claims.

• Direct denials to the relevant Epic work queues or outsourced business partners.

• Stay updated on Medicare, Medicaid, Health Safety Net, and RAC policy changes, raising any concerns as necessary.

• Monitor and refresh outstanding accounts receivable balances in Epic for insurance, self-pay, and credits.

• Inform management of changes that may impact workgroups.

• Advise management regarding potential compliance issues.

• Participate in in-services and payer seminars while keeping current regulatory documentation up to date.

⛳️ Requirements

• A Bachelor’s degree in a Business or Healthcare-related field is preferred, or an equivalent combination of formal education and work experience.

• 2 to 3 years of relevant on-the-job training or experience in healthcare billing and collections, encompassing Medicare, Medicaid, Blue Cross, HMO, and commercial insurance.

• Familiarity with healthcare billing and collection processes, as well as federal and state collection laws, legal collection practices, and collection techniques.

• Experience with Epic Resolute is preferred.

• General understanding of medical billing and collection processes is preferred.

• Basic knowledge of healthcare terminology is preferred.

• Familiarity with contracted payers is preferred.

• Proficiency in Microsoft Suite, particularly Excel, Word, and Outlook.

• Technical proficiency in Resolute Hospital and Professional billing, with the ability to navigate Epic modules for account research.

• Ability to navigate payer websites and portals for remittance research and data gathering.

• Proficient in medical billing and remittance forms and processes, including 835 and 837 files, as well as UB04 and CMS-1500 (HCFA) forms.

• Proficiency with BMC’s legacy systems may be required.

• Must comply with BMC’s RESPECT behavioral standards.

• Must maintain knowledge of applicable billing regulations, HIPAA privacy and security regulations, and relevant state and federal laws.

• Certificates, licenses, and registrations: None.

🏝️ Benefits

• Medical, dental, vision, and pharmacy benefits.

• Discretionary annual bonuses.

• Merit increases.

• Flexible Spending Accounts.

• 403(b) savings matches.

• Paid time off.

• Opportunities for career advancement.

• Resources to support the well-being of employees and their families.