Position Summary

Facilitate timely and accurate submission of all claims for hospital, clinics and Skilled Nursing Facility services. This includes pre-billing and/or billing of assigned accounts including but not limited to Inpatient Acute Inpatient and Outpatient Services, Skilled Nursing Facility and other assigned service lines. Review, correct, and generate claims to payors timely and accurately. Utilize a hybrid method of paper and electronic billing methods to submit and review patient claims. Perform timely and accurate follow-up of claims for hospital services in order to maximize cash collections and minimize uncollected accounts.

Essential Duties and Responsibilities

• Review and correct all claims in error through manual and electronic billing system daily.
• Review worklist daily for claims that require follow-up.
• Work the 72-hour report on a daily basis.
• Maximize reimbursement and minimize billing rejections by submitting appropriate claims according to department policies and procedures while following appropriate government guidelines.
• Demonstrated effective expertise in acute care billing.
• Ability to identify and communicate billing trends impacting cash.
• Request prior authorizations or retro authorizations as needed for hospital services.
• Current familiarity with the UB04 claim form, charge master and compliance resources.
• Assist in the preparation of payor credit balance reporting and other audits projects as required.
• Review accounts and perform account follow-up timely and efficiently.
• Resolve unbilled or unpaid claims, including rebilling of claims with late or corrected charges.
• Submit appeals and perform follow-up for daily correspondence received.
• Bill secondary commercial payors once the primary insurance has paid correctly.
• Request Medical Records and EOB's/RA's as needed.
• Enter adjustments according to department Write-Off policy and procedure.
• Ability to identify and communicate trends impacting cash.
• Review self-pay and self-pay after insurance accounts as assigned to ensure accurate and timely billing of patient statements.
• Review insurance refund request, verify if refund request is valid and process accordingly.
• Maintain daily productivity reports.
• Operates with a high level of autonomy to identify trends, analyze and resolve account follow-up activities.
• Assist Patient Registration with coverage as needed to register patients or answer incoming calls.
• Accepts and performs other duties as assigned.
• Follows Hospital and Department policies and procedures at all times, including but not limited to: Administrative Manual, Environment of Care, Human Resources, Infection Control, Corporate Compliance, Code of Ethics, etc.
• Attend, actively participate and complete in-services, training classes, mandatory classes, seminars/workshops, staff meetings, exercises and drills; reads all department communication and assigned materials.
• Customer Service - Provides excellent customer service and shows compassion to all patients, visitors and co-workers. Seeks feedback to ensure all needs are met. Anticipates and recognizes the concerns of others, even if those concerns are not openly expressed.
• Communication ¬- Keeps manager and team informed of progress, problems, development and plans. Gets along and interacts positively with co-workers and others.

Qualifications

• High School Diploma or equivalent, with minimum of (2) years related work experience in a hospital setting.
• Knowledge of Medicare, Medi-Cal, Managed Care, HMO, PPO, Industrial and Third party regulations.
• Working knowledge of basics of contracting concept, prior authorization requirements, CPT and ICD9/10 coding, procedure for billing or adjusting late charges, duplicate charges, incorrect or incomplete codes.

• Strong communication skills; including interactions payors, patients, physicians and colleagues.
• Basic Keyboarding skills and computer proficiency (Microsoft Office) (EMR knowledge a plus).
• Ability to effectively present information, both verbal and written.
• Ability to take initiative, adapt to changing priorities, and work independently.
• Strong time management and prioritization skills.
• Ability to multi-task with a high level of efficiency and attention to detail.

Physical Requirements

While performing the duties of this job, staff is regularly required to sit, stand, walk, talk, and/or listen. He/she uses his/her hands to do computer work, write reports, do equipment set-up/cleaning/storage, clerical support, etc. He/she will be using the phone frequently. Good vision is needed to be able to read schedules, enter accurate data, etc. He/she must have good general health and demonstrate emotional stability so as to carry out the above-enumerated duties.

• Able to lift up to 30 pounds.
• Stand, walk, and move 50% of the day.
• Use proper body mechanics when handling equipment.

Compliance Requirements

Complies with Chinese Hospital Compliance Handbook including Code of Ethics and all statutes, regulations, guidelines applicable to federal and state programs. Responsibilities include, following the guidelines and reporting suspected violations of any statute, regulations, agreements or guidelines applicable to all healthcare programs.

Base Pay Scale

Starting at $25.80 - $35.67 per hour. The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.

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