The Lead Data Specialist provides guidance to Data Specialists to ensure appropriate and timely entry of charges, payments, and adjustments into the billing system.  The Lead Data Specialist handles electronic claims and remittances to insure charge interfaces are reconciled. 

Responsibilities:

• Imports charges from the electronic medical record and Orchard lab systems to the billing system on a daily basis, ensuring the accurate transfer of data. Monitors the accuracy and volume of charges entered into billing system via charge import and manual entry.  Works in collaboration with lab manager to identify and fix any discrepancies.  Identifies duplicates, exceptions and invalid entries and imports appropriately.  Works with Nextgen support to fix any outstanding issues.
• Daily verifies all billing edits, via crystal reports to ensure billing accuracies, for charges imported through Nextgen and Orchard, due to system limitations:

1. Bad Billing Provider
2. HPHC Ref MD
3. Medicare Review
4. Office Consults
5. Assignment
6. Invalid Subscriber
7. Medicaid Modifier

• Validates all claims prior to submission to third-party payers with the goal of submitting “clean claims” to payers upon first submission.  Reviews and corrects errors in charges relating to claim, demographic, and insurance information prior to and following submission to insurance carriers.
• Submits claims to third-party payers via electronic claim files.  Prepares and prints primary and secondary paper claims to be sent to third-party payers.
• Weekly prepares domestic and international patient statement run, for I-Bill production.
• Retrieves, imports, and reconciles electronic remittance files to validate payments.  Coordinates the resolution of system issues related to charge, claim and remittance processing with MIS, vendors, and third-party payers when necessary.
• Daily retrieves all reports from payers to address any failed and/or denied claims or files from the previous days claim submission.
• Places Retrieved 835 remittance files into the Ntierprise system for electronic posting and in the Third Millennium system for EOB retrieval and posting. Monitors and reports ongoing problems with claim production, import, or entry. When necessary coordinates the correction or improvement of charge and payment entry processes with Data Specialists.
• Conducts daily reporting of claim submission data and volumes and daily reporting of posting of insurance and Self-Pay payments to the billing system.  Supports the Patient Accounts Manager in preparing daily, weekly, and monthly reports.
• Daily updates all closed batches in the system for the entire clinic.  (Patient accounts and clinic staff batches).
• Performs other systems tasks and general Patient Accounting tasks as assigned, including but not limited to answering the general patient accounts phone line, posting address changes, scanning documents, sorting mail, and processing bank deposits.

Qualifications:

• High school diploma required.  Associates or Bachelor’s degree preferred.
• Two years healthcare related experience preferred in Patient Accounts or Management Information Systems department in a medical business environment.
• Knowledge of CPT and ICD9 coding preferred.
• Proficiency in keyboarding (minimum 45 wpm) to enter charges, payments and adjustments into billing system.
• Ability to perform repetitive work according to set procedures, sequence and pace.
• Ability to act in lead capacity to ensure Data Entry Specialists completes appropriate and timely entry of charges, payments, and adjustments into the billing system.
• Ability to perform effectively under pressures of deadlines and fluctuating work loads.

 
For additional information and to apply, please visit www.joslin.org




Joslin Diabetes Center is an EEO M/F/D/V