Billing Specialist

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POST DATE 8/20/2016
END DATE 10/20/2016

Partners HealthCare(PHS) Somerville, MA

Somerville, MA
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Entry Level (0 - 2 years)
High School Diploma or GED



As a not-for-profit organization, Partners HealthCare is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Womens Hospital and Massachusetts General Hospital, Partners HealthCare supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care and other health-related entities. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research.

Were focused on a people-first culture for our systems patients and our professional family. Thats why we provide our employees with more ways to achieve their potential. Partners HealthCare is committed to aligning our employees personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal developmentand we recognize success at every step.

Our employees use the Partners HealthCare values to govern decisions, actions and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk, and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration.
General Overview

The Billing Specialist reports to the Patient Accounts Manager and is responsible for the timely and accurate submission of billed claims (Primary and/or Secondary) to various payers. The Billing Specialist will send claims via EDI, Direct Data Entry and paper claims and work EDI rejections. This individual should have the ability to perform required tasks independently as well as contribute as needed in a team environment. They must also be able to perform effectively with a high degree of accuracy and productivity. This individual will also need to interact with various different departments.


Resolve and submit claims (both Primary and Secondary) on a daily basis that meet and/or exceed established Department Quality and Productivity standards.

EDI transmitting and rejection review.

Direct Data Entry of claims

Knowledge of industry and Payer requirements to ensure accuracy of claim data, required for claims acceptance and payment.

Validate address completion, provider number requirements, member id requirements, filing limit restrictions and all coding requirements (HCPCS, CPT, Diagnoses, and Procedures included).

Identify and resolve claim deficiencies and reference registration processes and system functionality in order to resolve and resubmit timely.

Ability to work as team member while assuming individual responsibilities.

Effectively update legacy system patient information and comment or post transaction codes appropriately.

Identify specialty claims and initiate alternate billing processes

Utilize all resources possible to obtain updated information including Payer websites, Payspan and NEHEN to verify eligibility whenever possible

Initiate the correct action required whenever necessary resubmit in a timely fashion

Escalate problems and issues promptly to Department leadership to expedite research/resolution


High school diploma or equivalent required

Prior patient accounting experience strongly preferred, preferably in a Hospital setting.
Preferred knowledge and understanding of UB04 and 1500 claim forms and data fields.
Preferred knowledge of electronic 837 claim files.
Knowledge of Epic systems a plus

Strong interpersonal skills required

Ability to effectively communicate with employees throughout the PHS network
Ability to identify problems and issues within daily billing processes
Basic knowledge of MS Office, most importantly Outlook, Excel and Word, is required
Knowledge of hospital billing is preferred
Attention to detail a must
Ability to multi-task required
Accurately and productively perform high volume output on a daily basis

Partners HealthCare is an Equal Opportunity Employer & by embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law.