Billing Specialist

Job Summary

Accurately prepares edits and submits bills in a timely manner, in accordance with requirement of third‑party payers. Conducts related activities to support the efficient operations of the department. Knowledgeable in all aspects of Agency policy and services. Maintains knowledge of all billing policies, regulations, rules and reimbursement.

• Coordinates and verifies patient information for completeness and accuracy, in a timely fashion; communicates with clinical staff, third‑party payers and patients on a regular basis.
• Verifies required signatures on patients’ documents, i.e. Patient Client Authorization Form
• Verifies all insurance data, coordinating benefits, responding to inquiries in a timely manner.
• Verifies patients’ insurance coverage and/or pay source, checking that all visits are made within established admission and discharge dates, if applicable.
• Reviews and checks paperwork visits entered to final bill for accurate date of service, number of visits duplicates; identifies discrepancies, notifies appropriate personnel as needed. Submits claims in a timely manner.
• Researches payment sources and patient balances to check for co‑insurance; follows appropriate steps to transfer balance to co‑insurance and/or directly bill the patient. Follows guidelines and procedures for billing self‑pay, bad debt funding sources.
• Researches old claims; identifies and resolves any existing problems; refers unusual or difficult problems to Patient Account Manager as necessary.
• Reviews, edits, and prepares claims to be submitted; forwards all appropriate information to third‑party payers as necessary.
• Works with Aging Report to decrease days in Accounts Receivables. Understands A/R balances and reimbursement practices.
• Maintains Excel spreadsheets.
• Conducts follow‑up and collections procedures on each account. Maintains billing files and documentation.
• Maintains knowledge of all billing policies, rules and regulations.
• Demonstrates specialized level of knowledge of reimbursement practices and of third‑party payer contracts.
• Posts third‑party remittance advice accurately with attention to detail. Understands debits and credits.
• Provides assistance to Patient Account Manager, i.e., with month‑end processes, including financial reports and other requested projects.
• Prepares, prints and submits all reports, documents and summaries on a regular basis.
• Utilizes interpersonal communication skills in order to exchange information in a clear and accurate manner within the agency as well as outside.
• Responsible for follow‑up with Manager on all questions/problems discovered and keep Manager informed.
• Establishes and maintains a work area that is well‑organized, clean and neat.
• Operates and maintains equipment carefully and in accordance with procedures.
• Takes initiative to help maintain commonly‑used equipment and work areas.
• Immediately reports unsafe conditions to appropriate personnel.
• Serves on appropriate agency committees.

• High school diploma or equivalent required. Associate’s Degree preferred.
• Two (2) years billing experience in a medical setting preferred. Demonstrated competency in typing, use of a calculator, professional telephone skills, filing, photocopying and fax operations. Previous experience with PCs and knowledge of the computer systems and software, including Excel and Word, as well as electronic billing required.
• Excellent command of the English language required. Ability to read and interpret general business reports. Ability to effectively present information and respond to questions from staff and managers.

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, is a trusted, integrated health care organization that fuels the latest advances in medical research, attracts the nation’s top specialty‑trained doctors, hones renowned services and innovative programs, and engages in the important discussions people need to have about their health and end‑of‑life wishes.

Care New England is helping to…