third party biller

South Shore Health • Weymouth, MA

84d

About The Position

The position involves accumulating data from Patient Access and Health Information Management to submit compliant third-party insurance and physician claims. The role requires initiating collection calls for payment on aged accounts receivable and generating reports for responsible insurance plans. The employee will maintain online collection worklists and claims editing software to ensure maximum efficiency. A key responsibility is to decipher reimbursement schemes for assigned insurances to complete the revenue cycle. The employee must maintain up-to-date knowledge of all Federal, State, and Insurance-specific billing regulations, policies, procedures, and code sets, and notify the manager of any changes affecting claim submission.

Requirements

• Knowledge of Federal, State, and Insurance-specific billing regulations.
• Ability to evaluate insurance reimbursement schemes.
• Experience with online claim editing software.
• Strong communication skills for patient interaction.
• Ability to generate reports and maintain documentation.

Nice To Haves

• Experience in healthcare billing and collections.
• Familiarity with Meditech and API payroll systems.
• Previous experience in a hospital or healthcare setting.

Responsibilities

• Accumulate data from Patient Access and Health Information Management for insurance and physician claims.
• Initiate collection calls for payment on aged accounts receivable.
• Generate reports for responsible insurance plans and maintain online collection worklists.
• Evaluate daily claim files 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 and submit status to manager.
• Initiate collection of aged accounts receivable through automated collector work lists.
• Collaborate with denial management staff for accounts requiring clinical intervention.
• Generate technical appeals as needed for account resolution.
• Communicate with patients for additional insurance or information needed to process claims.
• Use technology solutions to enhance work processes.
• Foster a culture of safety through personal ownership and commitment.

Benefits

• Full-time employment with a 40-hour work week.
• Hybrid working model.
• Opportunities for professional development and training.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Number of Employees: 5,001-10,000 employees