third party biller

Requisition Number

R-20964

Facility LOC0014 - 549 Columbian Street 549 Columbian Street Weymouth, MA 02190 Department Name SHS Patient Accounts Status Full time Budgeted Hours 40 Shift Day (United States of America) Compensation Pay Range $21.05 - $29.45 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. Generate reports for responsible insurance plans and maintain online collection worklists and online claims editing software for maximum efficiency. Decipher reimbursement schemes for assigned insurances to complete the revenue cycle. Maintain up to date knowledge of all Federal, State and Insurance specific billing regulations, policies, procedures and code sets. Retain knowledge of Hospitals Credit Collection Policy. Notify manager of any changes that would affect claim submission. Evaluate 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 worklist. Resolve unresolved accounts by contacting insurance companies via phone, e‑mail or designated web site to settle outstanding balances. Collaborate with denial management staff for accounts that require clinical intervention for an appeal process. Generate technical appeals as needed for account resolution. Provide manager with a detailed account history for any account that is considered uncollectible. Document collection efforts for all work list accounts 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. Determine if a refund is needed and forward to the appropriate refund agent. Initiate insurance retractions as needed for payments posted to the Hospital’s Unlocated Cash Accounts. Forward incorrect payments that require a check to the appropriate refund agent. Communicate with patients as needed for additional insurance or other information required to process a claim. Generate phone calls or letters as needed to obtain necessary insurance or related information before placing an account in self‑pay. Obtain proper verification of predefined patient demographic information and maintain documentation to verify identity. Embrace technological solutions to work processes and practices. Use the API payroll system to enter time worked, sick days, vacations and holidays. Use Meditech to access and run reports. Use Lotus Notes as a communication tool. Access provider websites for verification of accounts. Foster a “Culture of Safety” through personal ownership and commitment to a safe environment. Successfully answer safety questions in the annual mandatory education packet. Maintain a neat, organized work environment. Adhere to respiratory etiquette guidelines. Non‑Essential Functions Other duties as required. Attend and participate in staff meetings, in‑service meetings and other activities as related to job performance. Attend seminars, workshops and training sessions offered by providers. #J-18808-Ljbffr South Shore Health