The EDI Unit Assistant position in the EDI is responsible for all aspects of EDI production for UCSF Medical Center Patient Financial Services (PFS), Medical Group Business Services (MGBS), UCSF Benioff Children’s Hospital Oakland (BCHO), Hospice by the Bay, Community Connect and UCSF Physicians Group. The EDI production supports all electronic claim production to various payers, including Medicare, Medi-Cal, Anthem Blue Cross, Blue Shield, and Change Healthcare. The electronic claim generation represents approximately 90% of all claims production. The monthly claims volume processed can reach up to 100 thousand claims for hospital billing and up to 190 thousand claims for professional billing. The position also supports the Electronic Remittance Advice (ERA)
processes for UCSF, MGBS, BCHO, HBTB, and UC Physician Group and Electronic Funds Transfer (EFT) processes for UCSF, MGBS, BCHO and UC Physician Group. The ERA/EFT processes represent approximately 80% of all inbound payment transactions to UCSF Medical Center, MGBS and BCHO. Frequent contact with all units in Patient Financial Services and other billing groups, as well as, outside entities, such as Health Plans and EDI Clearing Houses, who partner with UCSF in EDI processes. Frequent access to the following applications, EPIC/ApEX, CLAREDI, Change Healthcare, WebXtender, Cirius’ Billing and Remittance Applications and various payer sites.
The final salary and offer components are subject to additional approvals based on UC policy. To see the salary range for this position (we recommend that you make a note of the job code and use that to look up): TCS Non-Academic Titles Search (https://tcs.ucop.edu/non-academic-titles) Please note: An offer will take into consideration the experience of the final candidate AND the current salary level of individuals working at UCSF in a similar role. For roles covered by a bargaining unit agreement, there will be specific rules about where a new hire would be placed on the range. To learn more about the benefits of working at UCSF, including total compensation, please visit: https://ucnet.universityofcalifornia.edu/compensation-and-benefits/index.html
- Billing knowledge and experience.
- Understanding of ICD10, CPT4, HCPCS, DRG.
- Knowledge of contracts, insurance billing requirements, UB04 claim form, worker’s compensation, HMOs, PPOs, capitation, Medicare, Medi-Cal and HIPAA compliance program regulations.
- High school graduate or GED certificate.
- One year or more of EDI/ERA work experience (837I, 837P and 835 file types) in a hospital billing office or vendor environment.
- An in-depth understanding of all aspects of electronic billing.
- Knowledge of insurance billing requirements, UB04 and HCFA 1500 claim forms.
- Good analytical and organizational skills, interpersonal, verbal, and written communication
- skills.
- Experience in computer operations, particularly file management and FTP processes.
- Knowledge of electronic billing systems (i.e., UGS on-line system, Cirius Prebill and Remittance Manager, etc.)
- Basic knowledge of the EPIC (ApEX) systems
- Ability to follow directions and written procedures.
- Must be a motivated individual with a positive attitude and exceptional work ethic.
- Maintain a working knowledge of copy and fax machines.
- Basic knowledge of Funds Transfer process.
- Excellent knowledge of Microsoft Office, Excel and Access.
- Knowledge of the mandated HIPAA regulations for security, PHI and confidentiality are essential requirements for this position.
- The ability to work onsite in our Emeryville office.
