Authorization Specialist/Biller

About the Role

Accurately prepares, edits, and submits bills in a timely manner, confirms eligibility, and obtains authorization in accordance with requirements of third-party payers. Conducts related activities to support the efficient operations of the department. Maintains knowledge of all billing, eligibility verification, coordination of benefits, and authorization policies, regulations, rules, and reimbursement.

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, Case Communications).
• Enters information on patients' profiles in Horizon, such as authorization, copay, deductible, and limitations specific to each patient’s insurance plan.
• Proactively tracks and follows up on authorization requests.
• Determines insurance eligibility by verifying benefits and insurance coverage for services and coordination of benefits.
• Effectively prioritizes work to complete job responsibilities and adjusts priorities based on policies and procedures.
• Completes job responsibilities within required timeframes and according to established schedules or workflow requirements.
• Runs daily reports to capture authorization requirements.
• Works effectively with others, promoting teamwork and cooperation among individuals and departments.
• Coordinates and verifies patient information for completeness and accuracy; communicates with clinical staff, third-party payers, and patients regularly.
• Verifies required signatures on patients’ documents (e.g., Patient Client Authorization Form).
• Verifies insurance data, coordinates benefits, and responds to inquiries in a timely manner.
• Checks patients’ insurance coverage and pay source, ensuring visits are within established admission and discharge dates.
• Reviews and checks paperwork visits entered for accurate date of service, number of visits, and duplicates; identifies discrepancies and notifies appropriate personnel.
• Submits claims in a timely manner.
• Researches payment sources and patient balances to check for co-insurance; follows steps to transfer balance to co-insurance or directly bill the patient.
• Follows guidelines and procedures for billing self-pay and bad debt funding sources.
• Researches old claims, identifies and resolves problems, and refers unusual or difficult issues to the Senior Manager of Patient Financial Services.
• Reviews, edits, and prepares claims for submission; forwards appropriate information to third-party payers.
• Works with the Aging Report to decrease days in Accounts Receivables.
• Understands A/R balances and reimbursement practices.
• Maintains Excel spreadsheets and conducts follow-up and collections procedures on each account.
• Maintains billing files and documentation.
• Stays knowledgeable of all billing policies, rules, and regulations.
• Demonstrates specialized knowledge of reimbursement practices and third-party payer contracts.
• Posts third-party remittance advice accurately with attention to detail.
• Understands debits and credits.
• Assists the Senior Manager of Patient Financial Services with month-end processes, including financial reports and other projects.
• Prepares, prints, and submits all reports, documents, and summaries regularly.
• Utilizes interpersonal communication skills to exchange information clearly and accurately within and outside the agency.
• Follows up with the Manager on questions or problems and keeps the Manager informed.
• Establishes and maintains a well-organized, clean, and neat work area.
• 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.
• Serves on appropriate agency committees.

Requirements

• High school diploma or equivalent required.
• Associate’s Degree in a related subject 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.
• Excellent command of the English language.
• Ability to read, analyze, and interpret general business reports.
• Ability to effectively present information and respond to questions from staff and managers.
• 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.

About Us

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—is a trusted, integrated health care organization that fuels the latest advances in medical research, attracts top specialty-trained doctors, hones renowned services and innovative programs, and engages in important discussions about health and end-of-life wishes. Care New England is helping to transform the future of health care, providing a leading voice in efforts to ensure the health of the individuals and communities we serve.