Overview
Under the general direction of the Department Manager or designee, the Sr. Client Operations Specialist will be responsible for compiling and submitting claims for eligible health care and other services or expenditures for private, state, or federal reimbursement on behalf of contracted clients with required deadlines. The Sr. Client Operations Specialist will utilize internal systems and insurance portals to capture service and expenditure data, verify insurance eligibility, resolve…
rejections, and monitor denials and payments.
The Sr. Client Operations Specialist will work within the Federal Claiming unit that specializes in the configuration of technical solutions and provides expertise and resources to local governmental agencies for the purposes of seeking federal reimbursement for eligible expenditures and services. Currently this unit provides medical billing or claiming solutions and support to over 250 contracted providers of school-based health, laboratory, or vaccine administration services.
Responsibilities
- Carefully review and analyze service or expenditure data provided by health care providers for discrepancies and/or missing data.
- Promptly validate data with providers, as appropriate.
- Verify insurance eligibility using insurance portals and prioritize liability by primary and secondary insurance.
- Review service claims held or rejected for missing data or incomplete elements.
- Process health care service and expenditure data required using internal systems.
- Analyze and monitor data, payments or denials to identify possible programmatic trends or issues.
- Troubleshoot issues to ensure timely processing of claims.
- Escalate issues appropriately, including gathering and providing detailed documentation to support and explain the issues.
- Serve as primary contact, representative, and subject matter expert to assigned clients.
- Review, maintain, update and disseminate program documents including reports, client information, manuals, and procedures.
- Provide ongoing outreach, education and communication to clients regarding program requirements, revenue performance and reimbursement opportunities.
- Collaborate with other team members to effectively and efficiently ensure customers receive timely responses.
- Keep abreast of any regulatory or program changes impacting requirements for reimbursement.
- Participate in testing of billing system upgrades or new applications, including suggesting and identifying areas for functionality improvements.
Qualifications
REQUIRED EDUCATION:
Bachelor's Level Degree or equivalent work experience
REQUIRED WORK EXPERIENCE:
- 3-5 years of related experience including but not limited to medical billing support, customer service, program coordination or administration
- Strong proficiency with Microsoft Excel
- Proficiency with other essential Microsoft Office applications (Word, Outlook, Teams)
- Strong oral and written communication skills
- Demonstrated ability to work independently to achieve objectives
- Work effectively in both team and individual environments
PREFERRED WORK EXPERIENCE:
- Federal claiming or medical billing experience
- Familiarity with Random Moment Time Study or other cost allocation tools.
Organization
Realize Your Opportunities – A Career at UMASS Medical School
Inside Workings at UMASS Medical School
The University of Massachusetts Medical School (UMMS), the Commonwealth's only public medical school, is proud of our role in serving the people of Massachusetts. Although, its the inside workings of UMMS that makes the difference.
Mission and Culture
- We're serious about our mission and about our people.
- Real World Impact - Our people get excited about our mission of real-world impact in health sciences education, research and public service.
- International Prominence and New Opportunities - As this institution has grown to national – and international – prominence, we've found new opportunities to train tomorrow's physicians, nurses and scientists, discover causes of and cures for disease and help improve the quality of health care.
- Deep Commitment - With our clinical partner, UMass Memorial Health Care, and our other teaching affiliates, we share a deep commitment to national distinction in patient care.
- Valued Partnerships – UMMS partners with Commonwealth Medicine, the health care consulting arm of UMMS. Also, UMMS partners with MassBiologics in scientific collaborations, technology management and creating partnerships for the development of products for the benefit of patients. These valued partnerships help us to provide services and programs to help meet our needs at UMMS and the public.
- Proud Contributors - People at UMMS enjoy the feeling of going to work every day knowing what they do is truly important and worthwhile.
- Complementary and Inseparable - These varied parts of our mission and culture are complementary and inseparable.
Careers
UMMS, the state's first and only public academic health sciences center, educates physicians, scientists and advanced practice nurses to heal, discover, teach and care, with compassion. UMMS is a world-class institution with opportunities to match.
Competitive Compensation – UMMS offers salaries that are competitive with Worcester-area employers. When combined with our generous benefits, perks, and paid time off, many job seekers are surprised to find a total rewards package that matches or exceeds their current situation.
Targeted Hiring Process – At UMMS, there are actually multiple hiring processes for different segments of our workforce. In nearly all cases, UMMS hiring process is decentralized, with qualified candidates screened and referred to an academic officer or manager with hiring authority.
24/7 Access to Employment Opportunities – iCIMS is our online job search and application system. iCIMS is available 24/7 to provide you with a convenient and up-to-date view of the available employment opportunities across our campuses. Updates are made daily and include all faculty and non-faculty position listings from every school and department within the UMMS. When you identify a position you are interested in and qualified for, apply online. New opportunities become available frequently so it pays to check back often!
Benefits
With outstanding benefits, competitive pay, extensive learning opportunities, and a stimulating and attractive work environment, UMMS may be exactly the employer you've been looking for.
- Superior Benefits - UMMS offers a wide range of benefits and perks that invite comparison with the best employers in the Worcester area – and with academic institutions anywhere. UMMS provides superior medical and dental coverage for you and your family, fully funded retirement plans, generous time off, a Tuition Assistance Plan – and much more.
- People Centered - UMMS is an employer, but it is also a community. Its comprehensive medical and dental benefits, retirement plans, and even paid holidays reflect an institution built around people, with a deep respect for their differences and needs.
- Commitment to Healthy Living - UMMS provides resources to help you balance work and life and encourages healthy living through great programs and discounts for fitness, physical activity, weight management, nutritional counseling and general wellness available through our health insurance plans.
- Breadth of Offerings - Above all, the breadth of UMMS offerings set the School apart and makes it an environment favored by all sorts of smart, career-savvy people.
Apply for a Job
As an equal opportunity and affirmative action employer, UMMS recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds.
Online - To view all job opportunities and apply online, visit www.umassmed.edu/hr and click on the "Careers" tab.
Start Now and Realize Your Opportunities!
A History of Making Vital Improvements - UMASS Medical School Milestones
- 1962: Legislation establishes University of Massachusetts Medical School
- 1970: First medical students begin classes in Shaw Building
- 1974: First class graduates 16 MDs
- 1979: PhD program begins
- 1986: Graduate School of Nursing opens
- 1986: PhD program becomes Graduate School of Biomedical Sciences
- 1994: Graduate School of Nursing initiates PhD program
- 1998: UMass Clinical System and Memorial Health Care merge to form UMass Memorial Health Care
- 2001: Lazare Research Building opens
- 2002: Campus Modernization begins on the University Campus
- 2004: Graduate Entry Pathway Program established at the Graduate School of Nursing
- 2005: PhD Program in Clinical & Population Health Research established at the Graduate School of Biomedical Sciences
- 2005: Massachusetts Biologic Laboratories opens new manufacturing and filling facility in Mattapan
- 2006: Craig Mello, PhD, Blais University Chair in Molecular Medicine and Howard Hughes Medical Institute Investigator, is awarded the Medical School's first Nobel Prize. Dr. Mello shared the 2006 Nobel Prize in Physiology or Medicine with Andrew Fire, PhD, of Stanford University, for their discoveries related to RNA interference.
- 2007: Michael F. Collins, MD, is named chancellor and Terence R. Flotte, MD, is named dean of the School of Medicine.
- 2009: Groundbreaking for the Albert Sherman Center, a 500,000-square-foot research and education facility slated for completion in 2012.
- 2010: Ambulatory Care Center opens
- 2012: The Albert Sherman Center, a 500,000-square-foot research and education facility, completed and opens