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Care New England · 1 day ago

Authorization Specialist/Biller

Warwick, RI

Full-time

Onsite

New Grad, Entry Level

0+ years exp

Care New England is a health system that includes various hospitals and healthcare services. They are seeking an Authorization Specialist/Biller who will accurately prepare, edit, and submit bills while confirming eligibility and obtaining authorization from third-party payers.

AssociationHealth Care

Responsibilities

Obtains accurate and complete insurance coverage information and authorization for services utilizing electronic access when available

Understands prior approval and all authorization requirements and timeframes

Investigates and makes corrections in McKesson

Incorporates all new processes and requirements into daily work as requested

Accurately completes assigned processes. i.e. Au notes CB notes and BN notes as well as Case Communications etc

Enters Information on patients profile in Horizon -Such as Authorization, Copay, deductable, limitations specific to each patient’s Insurance plan

Proactively tracks and does follow up on authorization requests

Determines insurance eligibility by checking patients with benefits and insurance coverage for services and coordination of benefits

Effectively prioritizes own work in order to complete job responsibilities. Displays ability to adjust priorities based upon understanding of policies and procedures

Completes job responsibilities within required timeframe, according to established schedules or workflow requirements

Responsible for running daily reports to capture authorization requirements

Works effectively with others, helping solve problems and promoting teamwork and cooperation among individuals and/or departments

Coordinates and verifies patient information for completeness and accuracy, in a timely fashion; communicates with clinical staff, third-party payers and patients on a regular basis

Verifies required signatures on patients’ documents, i.e. Patient Client Authorization Form

Verifies all insurance data, coordinating benefits, responding to inquiries in a timely manner

Verifies patients’ insurance coverage and/or pay source, checking that all visits are made within established admission and discharge dates, if applicable

Reviews and checks paperwork visits entered to final bill for accurate date of service, number of visits duplicates; identifies discrepancies, notifies appropriate personnel as needed. Submits claims in a timely manner

Researches payment sources and patient balances to check for co-insurance; follows appropriate steps to transfer balance to co-insurance and/or directly bill the patient. Follows guidelines and procedures for billing self pay, bad debt funding sources

Researches old claims; identifies and resolves any existing problems; refers unusual or difficult problems to Senior Manager of Patient Financial Services as necessary

Reviews, edits, and prepares claims to be submitted; forwards all appropriate information to third-party payers as necessary

Works with Aging Report to decrease days in Accounts Receivables. Understands A/R balances and reimbursement practices

Maintains Excel spreadsheets

Conducts follow-up and collections procedures on each account. Maintains billing files and documentation

Maintains knowledge of all billing policies, rules and regulations

Demonstrates specialized level of knowledge of reimbursement practices and of third party payer contracts

Posts third-party remittance advice accurately with attention to detail. Understands debits and credits

Provides assistance to Senior Manager of Patient Financial Services, i.e, with month-end processes, including financial reports and other requested projects

Prepares, prints and submits all reports, documents and summaries on a regular basis

Utilizes interpersonal communication skills in order to exchange information in a clear and accurate manner within the agency as well as outside

Responsible for follow-up with Manager on all questions/problems discovered and keep Manager informed

Establishes and maintains a work area that is well-organized, clean and net

Operates and maintains equipment carefully and in accordance with procedures

Takes initiative to help maintain commonly-used equipment and work areas

Immediately reports unsafe conditions to appropriate personnel

Performs all other related duties as assigned

Qualification

Billing policies knowledgeInsurance verificationAuthorization processesExcel proficiencyMcKesson experienceOffice proceduresInterpersonal communicationProblem-solving skillsAttention to detailTeamwork