Third Party Specialist

Job Summary:

Under the direction of the A/R Supervisor, the Third Party Specialist facilitates all phases of the billing process. Responsible for submitting paper and electronic claims to all payers. Following up on current, past due accounts and secondary balances with third party payers, on claims that are denied or unpaid beyond the contracted time frame. Assist supervisor with reporting, analyzing and trending of the accounts receivable. The Third Party Specialist functions as a billing liaison to patients, providers, and insurance carriers, internal and external customers to ensure appropriate reimbursement on claims.

Duties and Responsibilities:

Review and resolves incomplete data elements identified on discrepancy reports required for billing.

Review bill for accuracy of charges, diagnosis, procedure codes and insurance information, and make appropriate adjustments/changes as required.

Follows appropriate procedure regarding rebilling functions for late charges and adjustments.

Responsible for following up on current and past due accounts to ensure a timely resolution of account.

Inform supervisor of denial trends and/or negative factors that impact the accounts receivable.

Utilize Care New England procedures and policies when addressing charity care, community benefit discounts, contractual adjustments, other adjustments, and patient discounts.

Adhere to insurance and governmental guidelines to prevent denials and collection disruptions.

Demonstrates knowledge of accounts receivable payment policies and hospital contracts as they relate to billing, collection, follow-up, claim reimbursement, patient liability, and local, state and federal programs.

Maintains knowledge and keeps current on updates and new procedures, benefit plans for third party payers and governmental plans.

Handle and process all incoming phone calls and mail correspondence from insurance and patients in a timely manner to ensure continuous collections.

Preserves and protects patient's rights to confidentiality.

Performs other related duties as requested.

Requirements:

High school degree required. Associates degree preferred.

Minimum of two years related experience in a health care environment or accounts receivable.

Knowledge of third party payers, medical terminology, word processing, statistical tools, and computer applications, including Excel highly desirable.

Must have excellent interpersonal, communication and typing skills, as well as demonstrate appropriate decision making/judgment skills when addressing the accounts receivable.

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 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.