THIRD PARTY BILLER

South Shore Health System; Weymouth, Northern (MA, KY); Hybrid; USD 29,000 - 41,000; Full time

Job summary

South Shore Health in Weymouth, MA, is seeking a full-time Patient Accounts professional to manage billing and collections responsibilities. The role requires accurate claim submissions, denial management, and patient communications within SHS Patient Accounts.

Hybrid/onsite work adaptability is considered, with a 40-hour work week and day shift. The position offers a pay range of $21.10 to $30.15 per hour, reflecting local market rates for a full-time billing specialist.

Responsibilities

• Keeps current knowledge of billing regulations, policies and codes; notifies manager of changes affecting claim submission.
• Reviews daily claim files for UB92 and 1500 submissions; initiates corrections per insurance rules.
• Pursues aged accounts via automated collector work lists; coordinates with denial management as needed.
• Generates monthly aging accounts reports for management review.
• Verifies insurance reimbursements and adjustments; determines refunds and forwards to refunds agent.
• Contacts patients for insurance or information needed to process a claim; verifies demographics.
• Uses API payroll system to enter time worked and leaves; uses Meditech and Lotus Notes; accesses provider websites.
• Maintains a safe, organized work environment and adheres to safety guidelines.
• Participates in staff meetings, training sessions and other activities as required.
• Supports organizational service standards, teamwork and effective communication within the department.

Job description

Job Details

Requisition Number: R-23517

Facility: LOC0014 - 549 Columbian Street549 Columbian Street Weymouth, MA 02190

Department Name: SHS Patient Accounts

Status: Full time

Budgeted Hours: 40

Shift: Day (United States of America)

Compensation Pay Range: $21.10 - $30.15

Responsibilities

1. 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. a. Notifies manager of any changes that would effect claim submission
2. Evaluates daily claim file using online claim editing software for submission of UB92 and 1500 claim forms. a. Initiate claim corrections as defined by insurance regulation and hospital policy.’ b. Evaluate unresolved accounts weekly, contact outside departments as needed and submit status to manager weekly to resolve unbillable accounts.
3. Initiate collection of aged accounts receivable through an automated collector work lists. a. Unresolved accounts require insurance company contact by phone, e-mail or designated web site to resolve outstanding balances. b. Collaborate with denial management staff for accounts than require clinical intervention for an appeal process. c. Generate technical appeals as needed for account resolution. d. Provide to manager a detail account history for any account that is considered uncollectable. e. All work list accounts must have collection efforts documented every 30 days unless otherwise notified.
4. Generate reports as needed for collection of aged accounts receivable. a. 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.
5. Evaluate insurance reimbursement schemes as needed to verify that payments and adjustments have been accurately recorded. a. 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. b. 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.
6. Communicate with patients as needed for additional insurance or other information needed in order to process a claim. a. Generate phone calls or letters as needed to obtain necessary insurance or other related information, prior to an account being placed in self pay. b. Obtain proper verification of predefined patient demographic information and maintain documentation in order to verify identity.
7. Technology – Embraces technological solutions to work processes and practices. a. Uses the API payroll system to enter time worked, sick days, vacations and holidays. b. Uses Meditech to access and run reports. c. Uses Lotus Notes as a communication tool. d. Access provider web sites for verification of accounts.
8. Safety Awareness – Fosters a “Culture of Safety” through personal ownership and commitment to a safe environment. a. Successfully answers safety questions in the annual mandatory education packet. b. Maintains a neat, organized work environment. c. Adheres to respiratory etiquette guidelines.

Non-Essential Functions

1. Other duties as required.
2. Attends and participates in staff meetings, in-service meetings and other activities as related to job performance.
3. Attend seminars, workshops and training sessions offered by providers.

Age Related Competencies

Does 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 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. (Department and/or individual performance standards may also be addressed in essential functions of position.) 7a - 330pm Hybrid Responsibilities if Required: Education if Required:

About South Shore Health

South Shore Health is a not-for-profit, charitable health system offering primary and specialty care, hospital care, home health and community care, emergency and urgent care, and preventative and wellness services. We are the largest independent health system in southeastern Massachusetts. South Shore Health brings together like-minded people who work “As One” toward a common goal of providing exceptional care the people of our region deserve. We unite top‑caliber talent, technology, and service with the wishes and personal needs of patients and their families to develop individualized treatment plans.