third party biller

South Shore Health•Weymouth, MA

2d•$21 - $29•Onsite

About The Position

South Shore Health is a not-for-profit, charitable health system offering primary and specialty care, hospital care, home health and community care, emergency and urgent care, and preventative and wellness services. We are the largest independent health system in Southeastern Massachusetts. South Shore Health brings together like-minded people who work “As One” toward a common goal of providing exceptional care the people of our region deserve. We unite top-caliber talent, technology, and service with the wishes and personal needs of patients and their families to develop individualized treatment plans. This role involves accumulating data from Patient Access and Health Information Management for the purpose of submitting compliant third party insurance and physician claims. The position also initiates all collection calls for payment on aged accounts receivable up to the point of self-pay collections. The Third Party Biller generates reports for responsible insurance plans and maintains online collection worklists and online claims editing software for maximum efficiency. An ability to decipher reimbursement schemes for assigned insurance’s is crucial to complete the revenue cycle.

Requirements

High School Diploma
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.
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.
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.
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.

Nice To Haves

If you are an existing employee of South Shore Health then please apply through the internal career site.

Responsibilities

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.
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.
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.