Billing Specialist

Job Summary

Accurately prepares edits and submits bills in a timely manner, in accordance with 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 policies, regulations, rules and reimbursement.

Responsibilities

• Coordinates and verifies patient information for completeness and accuracy; 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, coordinates benefits, and responds 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 visits entered to final bill for accurate date of service, number of visits, duplicates; identifies discrepancies and 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 and bad‑debt funding sources.
• Researches old claims; identifies and resolves any existing problems; refers unusual or difficult problems to the Patient Account Manager 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 Receivables; understands A/R balances and reimbursement practices.
• Maintains Excel spreadsheets and billing files and documentation.
• Conducts follow‑up and collections procedures on each account.
• Maintains knowledge 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.
• Provides assistance to the Patient Account Manager with month‑end processes, 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 clearly and accurately within the agency and externally.
• Follows up with the Manager on all questions/problems discovered 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.
• Serves on appropriate agency committees.

Requirements

• High school diploma or equivalent required; Associate’s Degree preferred.
• Two (2) years billing experience in a medical setting preferred.
• Demonstrated competency in typing, use of a calculator, professional telephone skills, filing, photocopying and fax operations.
• Previous experience with PCs and knowledge of computer systems and software, including Excel and Word, as well as electronic billing required.
• Excellent command of the English language required.
• Ability to read and interpret general business reports.
• Ability to effectively present information and respond to questions from staff and managers.

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