Billing Specialist

About the Role

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

Responsibilities

• 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, such as the 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, ensuring 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, and 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 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.
• 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 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 Patient Account Manager, including 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 as well as externally.
• Follows up with Manager on all questions or problems discovered and keeps 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 of 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—is 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 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 the ongoing effort to ensure the health of the individuals and communities we serve.