Job Abstract

What will you be doing in this role?

Under general supervision and following established practices, policies, and guidelines, provides Commercial and Government billing and collections support to Insurance Follow up and Accounts Receivable, performing duties which may include reviewing and submitting multi-specialty claims to third party payors, performing account follow-up activities, updating patient registration on accounts, etc. Positions at this level require expert knowledge, skill and proficiency in specialized functions and multiple areas of the revenue cycle. Incumbents have expert knowledge and understanding of regulatory requirements, payor contracts and CSHS policies governing billing and collections and sound interpretation of same. Incumbents are expected to research, analyze and resolve complex cases and problem accounts with minimal assistance. Serves as a technical resource (subject matter expert) to others and may act in the absence of the lead and/or supervisor. This position may be cross-trained in other revenue cycle functions, specialties, and provide back-up coverage.

In this role you will effectively bill, submit appeals and collect monies relative to physician reimbursements. You will be in charge of monitoring and processing accounts that are both straightforward or may need further research in order to bring resolution. You will work with minimal direction from management to ensure the integrity of the work performed. We work in a team environment to fulfill the mission and goals of the Department.

Requirements:

• High school graduate or GED required.
• Ability to read, write, understand and speak English effectively.
• A minimum of three years professional/physician billing and/or Collection experience – CMS1500 experience a plus. This physician billing experience includes corresponding with patients and insurance companies in resolving patient accounts. Extensive knowledge of insurance carrier procedures. Experience with reading Explanation of Benefits (EOB) statements.

Experience We are Seeking:

• Expert knowledge of medical terminology and coding (ICD, CPT, HCPCS, Modifiers, procedure, bill type, diagnosis, and revenue codes).
• Experience with MS office, Web/Vs, Availity and CS-Link preferred.
• Expert knowledge of regulatory and CSHS policies and procedures. Basic understanding of HIPAA and other privacy information guidelines
• Ability to perform business math.
• Successful completion of PRMPT 1.
• Ability to handle multiple tasks in a fast paced and high-volume environment with conflicting demands on time and attention. Ability to prioritize and organize work to complete assignments in a timely, accurate manner.
• Minimum 3 years’ experience in Commercial and Government billing and follow up. Office visits, procedures, outpatient and inpatient preferred.
• Ability to interpret regulations for Commercial Ins, CMS or Medi-Cal
• Professional and courteous demeanor.