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Summary:

Collection Representative ll plays an important role in the financial success of the hospitals. The duties include but are not limited to the efficient resolution of hospital third-party claims and patient balances. A Collection Representative ll collaborates with other areas of the Revenue Cycle including Access Services, Health Information Management, other areas of Patient Accounting, the numerous service areas, and insurance companies to achieve claim resolution. A successful Collection Representative ll will build relationships with our customers, both internal and external, to promote feedback and timely resolution of outstanding claims. The Collection Representative ll will need to be proficient in many software being utilized throughout the Revenue Cycle as well as the various Health Insurance websites. Additionally, a Collection Representative ll must understand the various insurance payment methodologies to ensure accurate reimbursement.

Job Responsibilities:

1) Expand current knowledge of all third party requirements including all managed care contracts and state and government regulations, to ensure compliant and accurate reimbursement.

2) Expand the ability to review, research, and obtain necessary information and/or documentation from various Revenue Cycle departments to address and resolve claim edits in order to submit electronically or manually according to payer specifications, as needed.

3) Expand skills and techniques to navigate the ever-changing payer portals, communicate with third-party payers to identify issues, and obtain necessary information in order to resolve outstanding balances.

4) Obtain supporting documentation and other information required to respond to the claim denials and secure payments.

5) Utilize web-based insurance verification systems to verify eligibility and update the information in the hospital billing systems, as needed.

6) Document pertinent account information pertaining to claims submission, status, and resolution.

7) Maintain a working relationship with third-party representatives to promote feedback and timely resolution of claims.

8) Interact and communicate effectively with inter-departmental units when necessary.

9) Expand knowledge to work and manage various reports and logs within the assigned time frameMiss matched buckets(ie., Mismatched buckets, Credit balances, and Billing Inquiries)

10) Meet and maintains department-specific training.

11) Maintains department-specific productivity and quality measurements and standards

12) Utilize all department and health system policies and procedures as related to Patient Accounting

Required Work Experience:

1) One-year of Hospital Medical Billing and/or Collection experience is required

Preferred Work Experience:

1) two or more years of experience preferred

Skills and Competencies:

1) Excellent PC skills required

2) Good oral and written communication skills

3) Ability to work with patients and staff in a professional and efficient manner to resolve issues

4) Able to work independently

You Belong At Baystate

At Baystate Health we know that treating one another with dignity and equity is what elevates respect for our patients and staff. It makes us not just an organization, but also a community where you belong. It is how we advance the care and enhance the lives of all people.

DIVERSE TEAMS. DIVERSE PATIENTS. DIVERSE LOCATIONS.

Education:

GED or HiSET (Required)

Certifications:

Equal Employment Opportunity Employer

Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.

Ab out Baystate Health

Baystate Health (BH) is one of New England’s leading and largest integrated health care organizations, serving a population of nearly one million people throughout western New England. With roots dating back to the founding of Springfield City Hospital in 1873, Baystate Health has been providing high-quality and compassionate health care in western Massachusetts for more than 145 years. With more than 12,000 employees, a medical staff of nearly 3,100 physicians, and a net patient service revenue of more than $1.4 billion, the ever-growing health system includes five Massachusetts hospitals and the Baystate Mary Lane Outpatient Center in Ware:

• Baystate Medical Center in Springfield

• Baystate Children’s Hospital (located at Baystate Medical Center)

• Baystate Franklin Medical Center in Greenfield

• Baystate Wing Hospital in Palmer

• Baystate Noble Hospital in Westfield