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Under the direction of the Supervisor, Professional Revenue Cycle, the Professional Biller II will service incoming telephone calls from patients who may question, challenge, or inquire about their account with CNE. The Professional Biller II, provides support to the management of CNE accounts receivable and functions as billing liaison to intermediaries, insurance carriers, patients and guarantors. The Biller II will be responsible for the processing of payments, denials, refunds, secondary claims, filing and balancing monthly spreadsheets and functions as liaison between the Professional Billing Office and the Finance Departments of each operating unit. The Biller II will address edits/rejections and facilitates all activity in regards to electronic and paper claims submission. Maintains and manages the claims edits and scrubber system. Functions under CNE PBO established departmental policies and procedures.  Maintains compassion with patients serviced, while following compliance and privacy guidelines. 

A.    Monitors accounts receivable by age from date of service and by patient.

B.    As necessary, communicates with insurance carriers, patients or medical office staff to appropriately adjudicate patient accounts.

C.    Seeks assistance from direct superior with difficult accounts to provide resolution to account balances or patient inquiries.

D.    Follows strict guidelines established by CNE when taking contractual adjustments off of gross charges, or writing off a charge or portion of a charge to bad debt.

E.     Prevents "timely filing" denials by strict adherence to guidelines set by carrier for follow-up to denied claims.

F.  Following established guidelines, utilizes the information system tools to provide an audit trail on each patient account through editing, adding insurance demographics, linking appropriate insurance demographics to charges and etc.G.  Pays close attention to correspondence from carriers and patients with a goal toward expedient resolution to outstanding claims and cash collections.

H.    Listens to patients issues, accesses the patient's account and either explains transactions as documented, or works with the patient to identify incorrect items that prevent the billing from being paid appropriately. 

I.    Maintains strict confidentiality  and compliance privacy protocols in in all dealings related to patients, physicians, accounts, fellow employees and the Care New England Health System.

J.     Responsible for posting insurance and patient payments into all professional billing Systems, posting insurance denials into all professional billing systems, appropriately processing insurance and patient refunds in a timely manner and generating secondary claims for additional processing.

K.    Daily balances all payments entered into the professional billing systems.

L.    Utilizes balancing procedures to prepare and maintain monthly spreadsheets to be provide reporting to Finance Departments.  M.    Provides assistance to co-workers within the department to meet weekly, monthly and yearly department goalsN.    Appropriately address claims that have failed edits or have been denied by the insurance carriers.

O.    Utilizes software systems to review and correct claims edits by carrier, prior to submission of claims to intermediaries and direct connect payers.

P.    Records and logs receipt of transmitted claims to payers, as well as take action within 24 hours in the event that claims transmission failed to be received by the carrier.

Q.    Reports trends, edits and scrubber errors to management to provide a means of training  for internal and external customers.

R.    Accesses patient medical records as required to provide appropriate information for billing resolutions. Accesses patient inquiry and patient transaction screens as appropriate to review billing history with a patient to provide resolution to patient's billing concern.

S.    Works closely with other Biller II to ensure telephone coverage at all times during established working hours.

T.    Perform other related job duties as assigned.

High school graduate or equivalent required with three to five years experience in third party medical billing. Working knowledge of medical accounts receivable software programs and PC skills necessary. Competence in math and knowledge of GAAP accounting principles as well as CPT and ICD-10 requirements. Must have excellent communication and interpersonal skills as well as demonstrated ability to use initiative and independent judgment.

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 transform the future of health care, providing a leading voice in the ongoing effort to ensure the health of the individuals and communities we serve.

Americans with Disability Act Statement: External and internal applicants, as well as position incumbents who become disabled must be able to perform the essential job-specific functions either unaided or with the assistance of a reasonable accommodation, to be determined by the organization on a case-by-case basis.

EEOC Statement: Care New England is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status

Ethics Statement: Employee conducts himself/herself consistent with the ethical standards of the organization including, but not limited to hospital policy, mission, vision, and values.