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South Shore Health · 1 week ago

third party biller

Weymouth, MA

Full-time

Onsite

New Grad, Entry Level

$20/hr - $27/hr

South Shore Health is a healthcare organization that is seeking a Third Party Biller. The role involves accumulating data for submitting insurance claims, managing aged accounts receivable, and ensuring compliance with billing regulations.

Health CareHome Health CareHospitalNon Profit

Responsibilities

Accumulate data from Patient Access and Health Information Management for the purpose of submitting compliant third party insurance and physician claims

Initiate all collection calls for payment on aged accounts receivable up to the point of self-pay collections

Generates reports for responsible insurance plans and maintains online collection worklists and online claims editing software for maximum efficiency

Ability to decipher reimbursement schemes for assigned insurance’s to complete the revenue cycle

Maintains up to date knowledge of all Federal, State and Insurance specific billing regulations, policies, procedures and code sets

Retains knowledge of Hospitals Credit Collection Policy

Notifies manager of any changes that would effect claim submission

Evaluates daily claim file using online claim editing software for submission of UB92 and 1500 claim forms

Initiate claim corrections as defined by insurance regulation and hospital policy

Evaluate unresolved accounts weekly, contact outside departments as needed and submit status to manager weekly to resolve unbillable accounts

Initiate collection of aged accounts receivable through an automated collector work lists

Unresolved accounts require insurance company contact by phone, e-mail or designated web site to resolve outstanding balances

Collaborate with denial management staff for accounts than require clinical intervention for an appeal process

Generate technical appeals as needed for account resolution

Provide to manager a detail account history for any account that is considered uncollectable

All work list accounts must have collection efforts documented every 30 days unless otherwise notified

Generate reports as needed for collection of aged accounts receivable

Accumulate at the beginning of each month or as requested a listing of unresolved/open accounts with aging greater than 120 days for manager review

Evaluate insurance reimbursement schemes as needed to verify that payments and adjustments have been accurately recorded

Review credit balance accounts in assigned worklist, review payment history for accuracy

Make a determination if a refund is needed and forward to the appropriate refund agent for resolution

Initiate Insurance retractions as needed for payments posted to the Hospitals Unlocated Cash Accounts

Incorrect payments that require a check will be forwarded to the appropriate refund agent for resolution

Communicate with patients as needed for additional insurance or other information needed in order to process a claim

Generate phone calls or letters as needed to obtain necessary insurance or other related information, prior to an account being placed in self pay

Obtain proper verification of predefined patient demographic information and maintain documentation in order to verify identity

Technology – Embraces technological solutions to work processes and practices

Uses the API payroll system to enter time worked, sick days, vacations and holidays

Uses Meditech to access and run reports

Uses Lotus Notes as a communication tool

Access provider web sites for verification of accounts

Safety Awareness – Fosters a “Culture of Safety” through personal ownership and commitment to a safe environment

Successfully answers safety questions in the annual mandatory education packet

Maintains a neat, organized work environment

Adheres to respiratory etiquette guidelines

Other duties as required

Attends and participates in staff meetings, in-service meetings and other activities as related to job performance

Attend seminars, workshops and training sessions offered by providers

Qualification

Insurance billing regulationsClaims submissionAccounts receivable managementMeditech proficiencyTechnical appeals generationSafety awarenessCommunication skillsTeamworkTime management

Required

Accumulate data from Patient Access and Health Information Management for the purpose of submitting compliant third party insurance and physician claims

Initiate all collection calls for payment on aged accounts receivable up to the point of self-pay collections

Generates reports for responsible insurance plans and maintains online collection worklists and online claims editing software for maximum efficiency

Ability to decipher reimbursement schemes for assigned insurance's to complete the revenue cycle