Healthcare A/R Analyst - Denials & Reimbursements

Care New England; Warwick (RI); On-site; USD 42,000 - 64,000; Full time

Job summary

Care New England is seeking a Third Party Analyst to proactively manage and analyze accounts receivable, focusing on current and past-due balances, denied or unpaid claims, and timely reimbursement. The role collaborates with patients, providers, and insurers to streamline billing processes and reports on AR trends.

The incumbent supports the supervisor with reporting, trend analysis, and acts as a liaison for all billing-related issues.

Qualifications

• Excellent interpersonal and communication skills.
• Strong typing skills and attention to detail.
• Ability to make appropriate decisions/judgment calls regarding accounts receivable.
• Solid understanding of insurance and governmental billing guidelines.
• Proficiency in documenting account activity and maintaining accurate records.

Responsibilities

• Track and maintain accounts receivable by aging categories.
• Review third-party credits to determine if adjustments, refunds, or recoups are needed.
• Communicate with insurance carriers, patients, and staff to resolve claim reimbursements.
• Manage secondary balances and denied/unpaid claims past contractual deadlines.
• Apply established policies and procedures for charity care, discounts, and adjustments.
• Accurately record account history and actions in systems within specified timeframes.
• Notify supervisor of denial trends or other A/R issues.
• Prepare reports and provide insight into accounts receivable trends.
• Follow insurance, state, and federal regulations, as well as internal policies.
• Safeguard patient confidentiality under HIPAA standards.
• Promptly handle phone calls, emails, and mail from insurance carriers and patients.
• Deliver excellent customer service when interacting with patients, providers, and insurers.
• Maintain positive relationships with internal and external stakeholders.
• Prioritize tasks to meet deadlines.
• Identify and recommend improvements to billing, workflow, or claims processes.
• Maintain familiarity with hospital contracts and payment policies to ensure consistent reimbursement.
• Collaborate with peers and management to achieve departmental objectives.
• Contribute ideas and feedback during team meetings.
• Assist coworkers as needed to optimize performance.
• Engage in relevant training, workshops, and professional development.
• Stay current on healthcare billing regulations and payer guidelines.
• Maintain punctual attendance and professional conduct.
• Adhere to dress code and appearance guidelines.
• Perform other duties as assigned by leadership.

Skills

Interpersonal skills

Typing speed

AR decision making

Billing guidelines

Record keeping

Education

High school diploma

Job description

Care New England is seeking a Third Party Analyst to proactively manage and analyze accounts receivable, focusing on current and past-due balances, denied or unpaid claims, and timely reimbursement. The role collaborates with patients, providers, and insurers to streamline billing processes and reports on AR trends.

The incumbent supports the supervisor with reporting, trend analysis, and acts as a liaison for all billing-related issues.