Title: Billing Representative III Location: Somerville-MA time type Full time job requisition id RQ4064169 Site: Mass General Brigham Incorporated Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Job Summary Responsible for maintenance of accurate billing records of complex customer and/or patient accounts, process payments and adjustments, and communicate with customers to answer questions or provide information. Participates in peer review to ensure accuracy and timeliness standards are maintained. Essential Functions -Interact with internal and external customers to gather support data to ensure billing accuracy and work through billing discrepancies. -Addresses issues of a more complex nature and support junior staff by answering day to day questions. -Peer reviews records for management to ensure accuracy of information. -Process payments and maintain up-to-date billing records. -Reprocessing insurance denials and submitting all necessary documentation for payment. -Collaborate with other departments to resolve billing and payment issues. -May prepare monthly and quarterly billing reports for management review. Qualifications Education High School Diploma or Equivalent required Experience Billing Experience 2-3 years required Knowledge, Skills and Abilities - Strong attention to detail. - Excellent interpersonal, written and verbal communication skills. - Proficient in Microsoft Office Excel and other relevant billing software. - Ability to prioritize and manage multiple tasks simultaneously. - Ability to work independently and as part of a team. - Ability to work in a fast-paced environment. Additional Job Details (if applicable) • M-F 8:30-5 PM EST schedule •Hybrid onsite position in Somerville, MA - monthly attendance Remote Type Hybrid Work Location 399 Revolution Drive Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) Pay Range $19.81 - $28.30/Hourly Grade 3 At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package. EEO Statement: 0100 Mass General Brigham Incorporated is an Equal Opportunity Employer. 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. We will ensure that all individuals with a disability are provided a 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. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

Verify patient insurance coverage and benefits, maintain accurate patient account records, communicate clearly with patients regarding their accounts, and resolve claim denials through evidence-based appeals to insurance carriers.

• Execute monthly billing cycles across multiple business segments using SAP BRIM • Review and validate rating, charging, and invoicing data • Perform detailed pre- and post-billing reconciliations • Conduct audits of billing data to ensure compliance • Develop and maintain billing dashboards and KPI reports • Collaborate with various teams to support billing dispute resolution

Role Description The Utilization Rate Specialist is responsible for monitoring, analyzing, and optimizing workforce utilization to ensure effective allocation of resources and alignment with organizational productivity goals. This role supports operational efficiency by tracking utilization metrics, identifying trends and gaps, and providing actionable insights to management. The specialist collaborates with business leaders, finance teams, and workforce planners to ensure appropriate staffing levels, improve capacity planning, and maximize billable or productive time. They play a key role in maintaining data accuracy, generating regular reports, and recommending process improvements to enhance overall performance. This position can be done remotely. Primary Responsibilities: - Review and process service authorization requests in accordance with regulations and state Medicaid guidelines. - Ensure that service authorizations align with individualized treatment plans and client needs. - Communicate with internal teams, external providers, and stakeholders to ensure timely and accurate processing of service authorizations. - Track and document service authorizations, updates, and renewals to ensure compliance with state and federal requirements. - Conduct intake assessments for new clients to determine eligibility and appropriate level of service. - Coordinate with clinical staff to ensure that all necessary information is obtained for authorization and service planning. - Manage the renewal process for ongoing services, ensuring that reauthorization is completed in a timely manner to avoid service disruptions. - Update and maintain client records with accurate, comprehensive information about services provided and client progress. - Monitor and assess staffing patterns to ensure adequate coverage for client services while meeting the standards set by regulations. - Collaborate with program managers and clinical staff to ensure that staffing aligns with service utilization and compliance requirements. - Recommend adjustments to staffing plans based on service demand, client needs, and efficiency goals. - Review and process exception rate requests for clients who require services outside the standard rate or service parameters. - Collaborate with clinical teams to assess the necessity and justification for exception rate requests. - Submit exception rate documentation to appropriate funding and regulatory bodies, ensuring that all necessary information and justifications are included. - Continuously evaluate service utilization processes to identify opportunities for improvement in efficiency, quality, and compliance. - Actively participate in team meetings and collaborate on initiatives to optimize the client experience while ensuring regulatory compliance. - Attend conferences, trainings, seminars and other professional skill development and enhancement activities as approved by leadership. - Perform other duties as assigned or requested. - Adhere to BSLS Core Values, Mission Statement, and Corporate Philosophies. Qualifications - Bachelor’s degree in a behavioral health related discipline is preferred. - A minimum of 3-5 years’ previous experience in a human service-related field, preferably behavioral healthcare. - At least 2 years of experience in mental health service authorization or utilization management within a community residential setting. - Must pass criminal background checks, central registry check (in applicable states) and child abuse registry (in applicable states). - Must complete and pass a drug test, in applicable states. - Must possess a valid Driver’s License and have reliable transportation. - Proficient in speaking, reading and writing the English language. - Experience with billing, budgets, spreadsheets and working with authorizations is required.