Team Lead, Accounts Receivable and Utilization Review - Hybrid, 847 Rogers St, Lowell

Hours: 40 hours per week - Monday through Friday from 8:00 AM to 4:30 PM or 8:30 AM to 5:00 PM. Must be available to be on-call on the weekends.

Location: Hybrid working model. Required to work onsite once per week at 847 Rogers St. Lowell, Massachusetts.

Requirements: 3-4 weeks of onsite training required to start.

Job Profile Summary

This role focuses on activities related to revenue cycle operations such as billing, collections, and payment processing. In addition, this role focuses on performing the following Patient Financial Services duties: Facilitates the reimbursement for clinical services provided to patients. Submits claims to health insurers, follows up with health insurers about submitted claims, and performs appeals for non-clinical denials, etc. An organizational related support or service (administrative or clerical) role or a role that focuses on support of daily business activities (e.g., technical, clinical, non-clinical) operating in a "hands on" environment. The majority of time is spent in the delivery of support services or activities, typically under supervision. A specialist level role that requires very advanced knowledge of operational procedures and tools obtained through extensive work experience and may require vocational or technical education. Works under limited supervision for non-routine situations and may be responsible for leading daily operations, and trains, delegates and reviews the work of lower level employees, and problems are typically difficult and non-routine but not complex.

Job Overview

Responsible for assisting the Manager of Patient Access, Utilization Review, Accounts Receivable and Medical Records/Health Information Management Departments staff and helping the manager with running the day-to-day functions of the Health Information Management department run efficiently and productively with high quality results.

Job Description

Minimum Qualifications:

1. High school diploma or equivalent

2. Five (5) years of experience in accounts receivable and/or utilization review

Preferred Qualifications:

1. Supervisory/management experience

2. Seven (7) years of experience in accounts receivable and/or utilization review

3.

Duties and Responsibilities: The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list. Other duties and responsibilities may be assigned.

1.Instructs, problem solves and assists in monitoring employee's workload to ensure even distribution among staff.

2.Assigns tasks and schedules for team members

3.Creates and distributes reports around the team's progress and projects

4.Provides training of all (new and existing) employees along with the manager.

5.Ensures customer satisfaction through effective communication patterns.

6.Assists in developing, reviewing and revising policies and procedures.

7.Assists in providing in-services and training based on assessment of need.

8.Participates in the ongoing evaluation of department functioning and makes recommendations and implementations for change.

9.Actively participates in interviewing candidates.

10.Assists manager in preparing goals and objectives for department reviews.

11.Assists with orientation of new staff.

12.Orders department supplies as needed.

13.Takes initiative in problem solving and notifies manager appropriately.

14.Works with and supports other teams within the organization to optimize organizational success.

15.Demonstrates a knowledge and understanding of what to report to the CEO or Chief Compliance Officer when concerns of corporate compliance arise.

16.Ensures compliance within guidelines set forth by regulatory agencies (DPH, ERISA etc.) and demonstrates compliance with Home Health Foundation policies and procedures.

17.Practices confidentiality principles set by the agency and federal HIPAA/HITECH guidelines.

18.Participates in all mandatory in-services and management required courses.

19.Develops and reviews/audits records/tasks completed by teams' members for completion, accuracy, timeliness, and compliance to regulations.

20.Holds team members accountable by reviewing Epic reporting, overall job reliability, and monthly feedback to each employee

21.Provides or get resources to train and educate employees who need assistance in meeting their goals

22.Provides recommendations to strengthen internal contracts within the application department processes.

23.Makes certain that all applicable department work queues in the current EMR (Epic) are assigned and being worked timely and accurately.

24.Uses current Electronic Medical Record System (Epic) and agency-created report to identify, manage and report what cannot be billed - unbilled, billing, posting payments collections UR authorizations, and expose areas of opportunity to receive timely payment and avoid claim denials.

25.Updates and maintains authorization tools and. insurance changes

26.Updates and maintains and insurance change when found in claim denials

27.Assists manager in communication to other departments' staff regarding need for billing and payment for services rendered.

28.Sends quarterly Medicare Credit Balance Report (and any other payer reports) timely

29.Reviews and approves contractual adjustments on a regular basis

30.Escalates any "unbilled claims' that are within 21 days of timely filing

31.Monitors Accounts Receivables and Unbilled no less than weekly

Physical Requirements:

1.Frequently required to move about inside the office to access file cabinets, office machinery, etc.

2.Must be able to remain in a stationary position 90% of the time.

3.May need to occasionally lift and/or move up to 10-25 pounds.

4.Constantly operates a computer and other standard office equipment such as copy machine, phones, photocopier, fax machines and computer printers.

5.Specific vision abilities apply including close vision, distance vision and ability to adjust focus.

6. The noise level in the work environment is usually moderate

Skills & Abilities:

1.Ability to problem solve.

2.Ability to adhere to deadlines.

3.Works efficiently and accurately and is detail oriented.

4.Knowledge of computers, computer applications/software.

5.Customer satisfaction oriented.

6.Excellent verbal, written, organizational, interpersonal and analytical skills.

7.Ability to read/write and communicate in English.

8.Excellent interpersonal skills.

9.Ability to function well in very busy situations.

10.Responsible and reliable.

11.Good organization skills.

Tufts Medicine is a leading integrated health system bringing together the best of academic and community healthcare to deliver exceptional, connected and accessible care experiences to consumers across Massachusetts. Comprised of Tufts Medical Center, Lowell General Hospital, MelroseWakefield Hospital, Lawrence Memorial Hospital of Medford, Care at Home - an expansive home care network, and large integrated physician network. We are an equal opportunity employer and value diversity and inclusion at Tufts Medicine. Tufts Medicine does not discriminate on the basis of race, color, religion, sex, sexual orientation, age, disability, genetic information, veteran status, national origin, gender identity and/or expression, marital status or any other characteristic protected by federal, state or local law. We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation by emailing us at careers@tuftsmedicine.org.