Job Description

Unit Specific Duties:

Billing

• Ensures claims are billed timely and accurately using the Hospital Claims Scrubber Tool and billing system. Resolves claim edits.
• Collaborates with departments to resolve applicable claim errors.
• Reports all unbilled claim information and issues that may delay billing to Management to ensure there is no adverse effect on Hospital Cash Collections or Accounts Receivable. 

Customer Service

• Receives and processes correspondence and phone or online inquiries from patients, payers or any other third party in a timely and professional manner.
• Resolves patient billing inquiries and processes patient payments over the phone or in person.

Follow Up

• Follows up on unpaid and denied claims for account resolution.
• Resolves accounts by contacting managed care entities, other third party payer organizations or patients to facilitate timely payments.
• Performs research and makes determination of appropriate actions for payment resolution. Writes and submits appeals for denied claims.
• Keeps informed of managed care and contractual arrangements to resolve accounts by managed care payers. 
• Assigns root causes to denials based on research.

Payment Posting

• Posts daily cash and adjustments for Hospital and Professional billing.
• Resolves undistributed payments and performs cash reconciliation.
• Reports all payment issues to Management to ensure there is no adverse effect on Hospital Cash Collections or Accounts Receivable. 

Self Pay Credit Balances

• Resolves credit balances that are due to patients.
• Audits and reconciles accounts to confirm credit balance and submits refunds in a timely manner.

Qualifications

• High School Diploma or equivalent.
• Two (2) years related work experience in a Hospital, Physician, or other healthcare setting.
• Strong verbal and written communication skills.
• Works in a collaborative and team manner.
• Efficient organizational skills and effective reasoning, problem solving and critical thinking skills.
• Excellent typing skills.
• Ability to multi-task and demonstrate effective time management.
• Preferred knowledge and use of Microsoft Products: Outlook, Word & Excel.
• Strong attention to detail.
• Ability to process a high volume of work.

Unit Specific Qualifications

Billing

• Knowledge of medical terminology and billing.
• Prior experience with facility billing or a similar role.
• Understands Medicare, Medi-Cal, HMO, PPO and 3rd party rules and regulations.

Customer Service

• Prior experience in a customer service setting.
• Preferred knowledge of health insurance coverages.

Follow Up

• Experience with claim processing and denial follow up and resolution.
• Knowledge of insurance appeal writing.
• Basic knowledge of contracting.
• Understands Medicare, Medi-Cal, HMO, PPO and 3rd party rules and regulations.

Payment Posting

• Preferred cash and adjustment posting background with regards to quality control of payments and transactions to financial system.
• 10-key preferred.

Self Pay Credit Balances

• 10-key preferred.
• Knowledge of basic accounting practices and procedures.

License/Certification/Registration Requirements

None required

Ages of Patients Served

This position will serve all age groups.

Salary Range:

$31.20 - $46.80 USD Hourly

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