Grc Third Party Risk Analyst Jobs in Rhode Island

Reporting to the Supervisor of A/R Management, the Third Party Analyst proactively manages and analyzes Care New England's accounts receivable. By staying on top of current and past-due balances (including secondary accounts) and resolving denied or unpaid claims, the Analyst ensures accurate, timely reimbursement. This role collaborates closely with patients, providers, insurance carriers, and various stakeholders to streamline billing processes. Additionally, the Third Party Analyst supports the supervisor with reporting, trends analysis, and acts as a key liaison for all billing-related issues.

• 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.

Education & Experience:

High school diploma required.

Minimum of two years of related experience in a healthcare environment or accounts receivable required

Licenses:

N/A

Certifications:

N/A

Knowledge, Skills, & Abilities:

• 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.

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.