Third Party Biller/Professional Billing

Company: South Shore Health
Location: Weymouth
Posted on: April 4, 2025

Job Description:

Job Description SummaryThe Third-Party Biller/Professional billing will 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 insurances to complete the revenue cycle. We are looking for candidates with two years' experience in professional billing. Work Schedule: Monday through Friday, 8:00am - 4:30pm. This position has a hybrid option after 90 days.Job DescriptionKey Job Responsibilities: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 affect claim submissionEvaluates daily claim file using online claim editing software for submission of 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 list.
    • 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. 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.Technology - Embraces technological solutions to work processes and practices.
        • Uses the API payroll system to enter time worked, sick days, vacations and holidays.
        • Uses Epic to access and run reports.
        • Uses Microsoft Outlook as a communication tool.
        • Access provider web sites for verification of accounts.Safety Awareness - Fosters a "Culture of Safety" through personal ownership and commitment to a safe environment.
          • Successfully answers safety questions in the annual mandatory education packet.
          • Maintains a neat, organized work environment.
          • Adheres to respiratory etiquette guidelines.Other duties as required.
            • Attends and participates in staff meetings, in-service meetings and other activities as related to job performance.
            • Attend seminars, workshops and training sessions offered by providers.Job Requirements:Minimum Education High school graduate or above preferred.Minimum Work Experience2 years of hospital and/or physicians billing required.Additional Skills, Knowledge, and Abilities:
              • Excel, Word and windows-based computer skills are required
              • Strong analytical skills needed to meet assigned objectives
              • Working knowledge of standardized health care CPT, HCPC and ICD9 codingCompetenciesDoes this employee provide any patient care related services? Yes _ No X Organizational Competencies Service The extent to which an employee demonstrates an understanding of the organizational and department's service standards and strives to achieve them, treats patients and families with dignity, compassion and respect at all times, and demonstrates courtesy in interactions with members of all departments and disciplines within the Hospital.Teamwork The extent to which an employee acts as a cohesive member of a work team and demonstrates appropriate interactions with all Hospital service providers.Communication Fosters an environment that nurtures collaboration, teamwork and mutual respect through effective communication, and demonstrates positive communication skills evidenced by effective working relationship.Respect For Others Takes actions that indicates a consideration for others and awareness of the impact of one's behavior on others, demonstrates respect for diverse backgrounds of all patients, families, and co-workers, and seeks accommodations.Time and Priority ManagementOptimizes use of time by efficiently using resources to identify barriers and balance priorities. Efficiently utilizes tools, resources, techniques and/or systems to organize tasks. Balances multiple priorities simultaneously, assuring the timely and accurate completion of each task, while maintaining quality standards.Quality Awareness/Performance ImprovementThe extent to which an employee demonstrates an understanding of their role in maintaining a commitment to quality. Quality is the consistent provision of safe, effective and satisfying care and services.Safety Awareness Fosters a "Culture of Safety" through personal ownership and commitment to a safe environment. (Department and/or individual performance standards may also be addressed in essential functions of position.)

Keywords: South Shore Health, Hartford , Third Party Biller/Professional Billing, Accounting, Auditing , Weymouth, Connecticut