Insurance Biller/Professional Billing

South Shore Health; Weymouth (MA); Hybrid; USD 28,998 - 40,570; Full time

Job summary

South Shore Health in Weymouth is looking for a Third-Party Biller to manage insurance claims and collections. You will work full time from Monday to Friday, with a hybrid option available after 90 days.

The ideal candidate has at least 2 years of hospital billing experience and strong knowledge of CPT, HCPC, and ICD10 coding. Responsibilities include ensuring compliance in claims submissions and communicating effectively with patients and departments to resolve billing issues.

Qualifications

• Minimum 2 years of hospital and/or physicians billing experience.
• Strong analytical skills to meet assigned objectives.
• Working knowledge of standardized health care CPT, HCPC and ICD10 coding.

Responsibilities

• Accumulate data for compliant third-party insurance claims.
• Initiate collection calls for aged accounts receivable.
• Evaluate insurance reimbursement schemes for accuracy.

Skills

Analytical skills

Excel

Word

Windows-based computer skills

Education

High school graduate or above preferred

Tools

Epic

API payroll system

Microsoft Outlook

Job description

Overview

Job Requirements

If you are an existing employee of South Shore Health then please apply through the internal career site.

Requisition Number
R-23057

Facility
LOC0014 - 549 Columbian Street 549 Columbian Street Weymouth, MA 02190

Department Name
SHS Patient Accounts

Status
Full time

Budgeted Hours
40

Shift
Day (United States of America)

Responsibilities

• The 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.
• 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 submission.
• Evaluates 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.

Qualifications

• Minimum Education
  High school graduate or above preferred.
• Minimum Work Experience
  2 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 ICD10 coding

Compensation & Schedule

• Compensation Pay Range
  $21.05 - $29.45
• Work Schedule: Monday through Friday, 8:00am - 4:30pm. This position has a hybrid option after 90 days.
• Work Hours: 40 per week; Shift: Day

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 relationships.
• Respect For Others: Takes actions that indicate 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 Management: Optimizes 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 Improvement: The 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.

Note: Monday through Friday 8:00am - 4:30pm