Job Summary:

Under the direction of the A/R Supervisor the Third Party Biller facilitates all activity in regards to electronic and paper claims submissions to various third party payers. Maintenance and management of the claims edits within the claim scrubber to ensure that claims are generated accurately, and submitted in a timely fashion. The Third Party Biller functions as a billing liaison and initiates communications with supervisors and other hospital personnel to ensure appropriate processing of claims.

Duties and Responsibilities:

Reviews diagnosis codes, procedure codes, provider information, insurance policy and group numbers for accuracy and completeness and corrects in system as required.

Reviews bill for accuracy of charges, and makes appropriate adjustments/changes to bill form and system as required in accordance to payer policies, contracts and/or department procedures.

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

Research and correct missing information on bill form, in order to address with other hospital personnel as necessary.

Report trends, edits and scrubber errors to supervisor to provide a means of communicating with hospital personnel.

Ensure timely review of bill holds and errors to prevent “timely filing” denials.

Attends and participates in staff meetings, workshops, and in-service training programs.

Responds to changing conditions and reprioritizes tasks as required.

Accurately documents account history in appropriate computer systems within defined time frames in accordance with departmental policies and procedures.

Respond to email, telephone calls and other correspondence on a daily basis in accordance with department policy and procedures.

Preserves and protects patient's rights to confidentiality.

Performs other related duties as requested.

Requirements:

High school graduate required.

Post graduate business courses and/or third party billing experience preferred.

Must have excellent analytical skills, an aptitude for figures, and experience with various computer applications.

Excellent communication and interpersonal skills as well as demonstrated appropriate decision making/judgment skills when addressing edits and rejections.

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 the nation’s 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.