Third Party Analyst

Children's Specialized Hospital Somerset, NJ

Job Summary

Ensure that billed accounts are resolved within established timeframes via timely and effective contact with third party payers and patients.

Essential Job Functions

* Perform account follow up to ensure prompt payment of claims. Ensure that all accounts on workstations are processed timely. Ensure that account balance is correctly stated by reviewing applicable contractual adjustments.

* Document all follow-up actions on-line. Refer aged and problem accounts to supervisor as necessary.

* Maintain familiarity with all hospital contracts. Evaluate contract compliance demonstrated by payors and bring discrepancies to management's attention.

* Investigate status and extent of third party coverage. Review demographics and financial information for accuracy and completeness. Identify and resolve deficiencies with an accuracy rate of 90% or better based upon periodic audits.

* Resolve all requests for additional information from third party payors, patients and other constituents.

* Review remittances and EOBS to ensure appropriate posting of payments and contractual adjustments.

* Work with billing to ensure that all necessary primary billing and secondary billing rejections are handled correctly.

* Maintain technical expertise on utilized computer systems.

* Perform all other duties as assigned.

RequirementsFormal Education and Job-Related Experience

* Ability to work effectively with patients, insurance company representatives and community representatives to obtain payment for services. Must be able to work independently. Regular attendance is required.

Education and Experience - Additional Comments

* High School Graduate. Two years of college preferred. Two years of medical account collection/business office experience. Data entry experience required. Must have knowledge of third party payor regulations.

Job Specific Contacts

* Patient Access Services, Health Information Management, Hospital personnel, Accounts Receivable Supervisor, Parents/Guarantors and Insurance Companies.

Physical Demands

* Typical Office Environment.

Working Environment - Additional Comments

* Concentration, manual dexterity, lift/pull file boxes, sensitivity to coworkers.

Job Provides Direction To

* None

* Full-time (40 hrs per/wk) position; Schedule: 8:00 am-4:30 pm

* Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities.

* Please view Equal Employment Opportunity Posters provided by OFCCP here.

* The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information.

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