Authorization Specialist/Biller

Job Summary Accurately prepares edits and submits bills in a timely manner, confirms eligibility, and obtains authorization in accordance with the requirements of third‑party payers. Conducts related activities to support the efficient operations of the department. Knowledgeable in all aspects of agency policy and services. Maintains knowledge of all billing, eligibility verification, coordination of benefits, and authorization policies, regulations, rules and reimbursement. Duties and 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 (e.g., Au notes, CB notes, BN notes, and case communications). Enters information on patients’ profiles in Horizon—such as authorization, copay, deductible, limitations specific to each patient’s insurance plan. Proactively tracks and follows 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, adjusting priorities based on policies and procedures. Completes job responsibilities within required timeframe, according to established schedules or workflow requirements. Runs 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 (e.g., 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 for 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 receivable; 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 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 (e.g., 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 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 keeps Manager informed. Establishes and maintains a work area that is well‑organized, clean and neat. 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. Requirements High school diploma or equivalent required. Associate’s degree in related subject(s) preferred. Six months of job‑related experience or equivalent required; demonstrated competency in office/clerical procedures, including typing, professional telephone skills, filing, photocopying, and fax operations. Previous experience with various software packages, PCs and database knowledge required. Ability to apply common‑sense instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations. Excellent command of the English language required; ability to read, analyze and interpret general business reports; ability to effectively present information and respond to questions from staff and managers. Care New England Health System (CNE) Care New England Health System (CNE) and its member institutions, Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, and our Wellness Center, are trusted organizations fueling the latest advances in medical research, attracting the nation’s top specialty‑trained doctors, and honing renowned services and innovative programs to engage in the important discussions people need to have about their health. Americans with Disability Act Statement External and internal applicants, as well as position incumbents who become disabled, must be able to perform the essential job‑specific functions either unaided or with the assistance of a reasonable accommodation, to be determined by the organization on a case‑by‑case basis. EEOC Statement Care New England is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status. Ethics Statement Employee conducts himself/herself consistent with the ethical standards of the organization, including, but not limited to, hospital policy, mission, vision, and values. #J-18808-Ljbffr