THIRD PARTY BILLER

Responsibilities

• Accumulate data from Patient Access and Health Information Management for the purpose of submitting compliant third party insurance and physician claims.
• Initiate all collection calls for payment on aged accounts receivable up to the point of self-pay collections.
• Generates reports for responsible insurance plans and maintains online collection worklists and online claims editing software for maximum efficiency.
• Ability to decipher reimbursement schemes for assigned insurance’s to complete the revenue cycle.
• Maintains up to date knowledge of all Federal, State and Insurance specific billing regulations, policies, procedures and code sets.
• Retains knowledge of Hospitals Credit Collection Policy. Notifies manager of any changes that would effect claim submission.
• Evaluate daily claim file using online claim editing software for submission of UB92 and 1500 claim forms.
• Initiate claim corrections as defined by insurance regulation and hospital policy.
• Evaluate unresolved accounts weekly, contact outside departments as needed and submit status to manager weekly to resolve unbillable accounts.
• Initiate collection of aged accounts receivable through an automated collector work lists.
• Unresolved accounts require insurance company contact by phone, e-mail or designated web site to resolve outstanding balances.
• Collaborate with denial management staff for accounts than require clinical intervention for an appeal process.
• Generate technical appeals as needed for account resolution.
• Provide to manager a detailed account history for any account that is considered uncollectable.
• All work list accounts must have collection efforts documented every 30 days unless otherwise notified.
• Generate reports as needed for collection of aged accounts receivable.
• Accumulate at the beginning of each month or as requested a listing of unresolved/open accounts with aging greater than 120 days for manager review.
• Evaluate insurance reimbursement schemes as needed to verify that payments and adjustments have been accurately recorded.
• Review credit balance accounts in assigned worklist, review payment history for accuracy. Make a determination if a refund is needed and forward to the appropriate refund agent for resolution.
• Initiate Insurance retractions as needed for payments posted to the Hospitals Unlocated Cash Accounts.
• Incorrect payments that require a check will be forwarded to the appropriate refund agent for resolution.
• Communicate with patients as needed for additional insurance or other information needed in order to process a claim.
• Generate phone calls or letters as needed to obtain necessary insurance or other related information, prior to an account being placed in self pay.
• Obtain proper verification of predefined patient demographic information and maintain documentation in order to verify identity.

Qualifications

• Technology – Embraces technological solutions to work processes and practices.
• Uses the API payroll system to enter time worked, sick days, vacations and holidays.
• Uses Meditech to access and run reports.
• Uses Lotus Notes as a communication tool.
• Access provider web sites for verification of accounts.

Benefits

• Compensation Pay Range $21.10 - $30.15

Schedule

Day (United States of America)

Pay

$21.10 - $30.15