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Receivables Resolution Specialist

Cape Cod Healthcare

Hyannis, MA
  • Administrative / Clerical
  • Financial Services
  • Information Technology
  • Healthcare
Cape Cod Healthcare
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Job Details

Cape Cod Healthcare

Department: Revenue Cycle
Schedule: Full-time 40 Hours per week
Shift: Day Shift
Hours: 8a-4p, Monday - Friday
Job Details:

Cape Cod Healthcare is the leading provider of healthcare services for residents and visitors of Cape Cod.  With more than 450 physicians, 4,700 employees, and 1,100 volunteers, Cape Cod Healthcare operates two-acute care hospitals, the Cape's leading provider of homecare and hospice services (VNA), a skilled nursing and rehabilitation facility (JML Care Center), an assisted living facility (Heritage at Falmouth), the Cape's only local laboratory service (CCHC Laboratory Services) and numerous health programs.  We are currently seeking a dedicated Receivables Resolution Specialist to join our team at Cape Cod Hospital.


Cape Cod Healthcare offers competitive salaries, excellent benefits packages, tuition reimbursement, and generous paid time off.



Perform accurate and timely account resolution.



1.     Perform accurate and timely follow-up, reconciliation and resolution of outstanding account balances.

2.     Analyze and resolve outstanding receivables utilizing remittance reports, payment advisories, explanation of benefits, etc.

3.     Verify accuracy of third party payments.

4.     Post contractual allowances where necessary.

5.     Refer accounts for billing where appropriate, reassign eligible balances to self pay and/or 3rd party billing status.

6.     Process third party payor denials and related correspondence in a timely and accurate manner.

7.     Perform administrative and clerical functions including but not limited to typing, photo copying, filing, calculating, faxing, etc., as assigned.

8.     Collaborate and interact with all departments to resolve edit errors.

9.     Maintain job knowledge adequate to effectively carry out the responsibilities of assigned insurance (s) group including CPT, HCPC, ICD-9 coding, occurrence, condition, span and value codes in addition to modifiers.

10.  Add and removes charge procedure codes, modifiers, and other codes, as directed by clinical department heads. 

11.  Maintain supporting documentation for all account changes with originating department sign-off.

12.  Pursue other insurance information through eligibility verification and check claims status utilizing online access and individual insurance carrier websites.

13.  Review billing, payment, and denial information utilizing a number of automated databases. 

14.  Identifies potential reason(s) for payment denial, initiates and follows through with appropriate remedial action.

15.  Utilize third party denial management system to provide reports and workflow denials. 

16.  Perform follow-up activities on unpaid accounts through downloaded trial balances, internet insurance websites, and other reports and/or claim listings where appropriate.

17.  Perform individual claim correction, adjustments, and cancels through online access to specific payors websites.

18.  Calculate patient liability and perform system adjustments to support accurate patient statement billing as needed.

19.  Respond to patient and/or insurer inquiries in a professional, timely, efficient and knowledgeable fashion, ensuring HIPAA and CCH guidelines are followed.

20.  Monitor credit balance reports and performs analysis making appropriate claims adjustments and/or refunds as necessary.

21.  Create and maintain logs and reports as needed to support Patient Account activities.

22.  Assists the department and acts as a team member by covering for absences, training activities, etc. in support of hospital and departmental work activities.

23.  Comply with departmental and organizational policies including but not limited to dress code, use of supplies, telephones and computers.

24.  Adheres to work schedules and maintains a safe and orderly work area at all times, maintaining awareness of and compliance with safety policies and procedures.

25.  Attends and participates in educational programs, in-service meetings, workshops, and other activities as related to job performance, job knowledge and state regulations.

26.  Ability to analyze automated computer output 

27.  Performs other job related duties and assignments as requested.

 Consistently provides service excellence to all patients, family members, visitors, volunteers and co-workers in a manner that reflects Cape Cod Healthcare's commitment to CARES: compassion, accountability, respect, excellence and service.




·   Ability to read, write and communicate in English.

·   2 years education beyond high school at a trade school, technical school or college in healthcare office practices, physician office practices, or financial services AND 1 year recent (within the past 5 years) experience using electronic billing or receivables systems OR minimum of 1 years recent experience (within the past 3 years) in a Medical Setting

·   Basic mathematics skills, and ability to apply skills, as demonstrated by successful passage of a timed business math test, using manual and calculator aided computations to solve problems.

·   PC skills, including Microsoft Excel, Word and Outlook, with a minimum of 6 months experience working with Meditech or similar information system on a daily basis.

·   Keyboarding skills at 35 WPM as demonstrated by successful passage of a timed test.

·   Successful passage of CCH A/R Resolution test OR 1 year recent (within the past 2 years) work experience in medical receivables resolution.

·   Successful passage of basic medical terminology course OR successful passage of the CCH Medical Terminology exam.   


HR Use Only:

Zip Code: 02601
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