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Job Details

Accounts Receivable Follow Up Biller

Date Posted: 05/18/2022

Requisition Number: 1999

Location: Commerce Place

Work Days: Monday - Friday 8am - 4:30 pm

Category: Clerical and Administrative Support

Department: Professional Billing

Job Type: Full time

Work Shift: Day

Hours/Week: 40

Union: Yes

Union Name: CH Laborers 380


The department provides critical oversight of the revenue cycle for Cambridge Health Alliance including actively participating in front end and back end processes.

Under the direction of PFS Management, this staff member is responsible for performing a variety of follow-up and billing tasks for all types of claims, as necessary and can include performing third party billing and collections for Inpatient, Outpatient and Observation claims via electronic, paper and telephone inquiries.

Adheres to hospital policies and procedures
Maintains patient privacy and confidentiality at all times according to the established hospital procedures to ensure that the dignity and respect of the patient is maintained.
Promotes a professional image by adhering to the established policies of the organization.
Attends all mandatory hospital and department training sessions.
Contribute to the goals set by the team and the department
Contributes to the overall efficiency of the Patient Financial Services Department.
Achieves productivity and quality goals set by management.
Productivity and quality goals to be established and revised at periodic intervals depending on fluctuations in account volume.
Communicates to management suggestions on how the team or the department can run more efficiently and increase its productivity
Provides back up to others in the department upon management's request.
Review and respond to messages in the billing system and/or email system
Review all messages for follow-up, respond as necessary
Refer accounts/messages requiring review or additional information from other revenue cycle areas as necessary
Follow-up regularly with necessary departments to ensure timely updates
Refer to Supervisor(s) and/or Manager(s) as needed
Prepare claims for billing from billing system
Review billing work queues and update accounts to allow claims to release
Refer accounts requiring review or correction to HIM, Patient Access, Clinical Departments, or other areas as necessary
Follow-up regularly with necessary departments to ensure claim submission guidelines are met.
Perform necessary eligibility verification in Passport, MMIS and any/all payer specific portals.
Correct claims in the claim scrubber system
Review assigned work queues and correct edits to allow claims to release
Refer accounts requiring review or correction to HIM, Patient Access, Clinical Departments, or other areas as necessary
Follow-up regularly with necessary departments to ensure timely updates and timely claim submission deadlines are met
Report any unresolved claims greater than 8 business days' t o supervisors
Government Team: work Medicare FISS and Medicaid DDE rejections
Non-Government Team: work applicable rejection assignments in Meditech and MedAssets
Process manual claims, if necessary
Prepare and submit claims for specified third parties/special billing exceptions
Process late charges and late credits
Identify accounts with late charges
Identify accounts with late credits
Submit rebill requests in the billing system when necessary
Document activity in the billing system
Review and Respond to mail correspondence
Review all incoming correspondence, prioritize and work towards resolution
Resolve accounts in the A/R Follow-up Work Queue (e.g., Collector Desktop, Denials Management Desktop, etc.)
At prescribed intervals, in accordance with the PFS Follow-up Guidelines: Contact third party payer to confirm that claim was received and is on file, and all other billing criteria has been met (e.g., the patient is eligible, authorization is on file, etc.) then add the appropriate account notes.
Continue to contact third party payer as prescribed to ensure timely adjudication and processing of any outstanding claim, including past due and denied accounts, then add the appropriate account notes
Document dates of all follow-up activity and results in the billing system
Update the billing system with any changes to financial class, insurance eligibility, etc., then add the appropriate account notes
Perform account adjustments as necessary
Obtain approvals prior to making any adjustments in accordance with hospital policy
Update and prepare claims for resubmission as requested
Review 835 denial reports/third party correspondence for follow up
Compile and review all paper denial correspondence from third party payers and document receipt in the billing system
Review all electronic 835 denial responses in the billing system
Contact the payer and appeal claims per payer guidelines
Refer accounts requiring additional information to appropriate revenue cycle department
Document dates of all follow up activity and results in the billing system
Perform account adjustments and write-offs per hospital policy and payer guidelines
Obtain necessary approvals prior to making adjustments in accordance with hospital policy
Involve Supervisor(s)/Manager(s) in account follow-up as appropriate.
Perform special departmental projects (as necessary)
Understand all the requirements of an assigned project
Follow through to completion on all phases of project
Complete the project within the required time limit
Process small credit balances
Identify credit balance requests from paper correspondence, work queues, and relevant reports
Generate adjustments in the billing system as necessary
Obtain adjustment sign-off according to escalation protocol
Request rebills when applicable
Request refund checks as needed
Document activity in the billing system


Other information:
3-5 years prior Medical billing/claims processing experience required.
Hospital Accounts Receivable billing, follow-up and analytics experience preferred.
Functional experience with Windows/Google applications (required) and EPIC (preferred).

In keeping with federal, state and local laws, Cambridge Health Alliance (CHA) policy forbids employees and associates to discriminate against anyone based on race, religion, color, gender, age, marital status, national origin, sexual orientation, gender identity, veteran status, disability or any other characteristic protected by law. We are committed to establishing and maintaining a workplace free of discrimination. We are fully committed to equal employment opportunity. We will not tolerate unlawful discrimination in the recruitment, hiring, termination, promotion, salary treatment or any other condition of employment or career development. Furthermore, we will not tolerate the use of discriminatory slurs, or other remarks, jokes or conduct, that in the judgment of CHA, encourage or permit an offensive or hostile work environment.

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