COLL REPR SR

Job Summary

This position works in the Dental Center Billing Office to assist with all aspects of the revenue cycle. The Senior Collections Representative helps with Claim submission, Accounts receivable, working denial, Patient Billing Inquiries, Correspondence, Payment Allocation and Process Improvement to ensure compliant and thorough collections of professional fees performed in the Dental Center.

Responsibilities

• Revenue Cycle Functions:

  • Claim Submission: Process paper and electronic claim forms to payors for chargeable and billable services. Resolve billing system edits (EDI/Charge Review) and determine the correction action to clear the error and produce clean claims for the Dental Center. Review key data within the claim form, such as provider, practice, CDT/CPT, fee, and ensure appropriate documentation is included for adjudication.

  • Correspondence: Reviews billing correspondence for timely resolution. Apply appropriate denial and claim status codes. Recognize insurance reimbursement issues, coding problems, and other issues that could affect the financial condition of the clinic. Work closely with the Revenue Cycle Director to resolve identified trends and problems.

  • Accounts Receivable: Follow up and reprocess claims as necessary. Research complex billing issues of each account; confirm primary and secondary payers, evaluate coordination of benefits; identify appropriate contracts/plans to provide payment for all phases of care. Analyze complex financial data and reports to identify trends contributing to aging accounts and common denials. Summarize findings to share with management.

  • Payment Allocation: Prepare and submit PeopleSoft journals for payments routing to PBS centralized Lockbox, MyChart deposits, ACH, EFT, i835, and insurance credit card. Maintain PBS excel spreadsheets for reconciliation, statistical, and audit purposes. Generate daily journals to transfer funds to the Dental Center Division General Ledger and record information in the excel database. Ensure all paper checks are transitioned to an electronic payment source. Maintain excel journal and deposit logs, reconcile monthly journals to ensure accuracy and completion against web links reports. Perform SAS 112 reconciliation.

  • Patient Billing Inquiries: Collaborate with clinic managers/supervisors and providers to resolve billing inquiries in-person, phone, email, standard mail, etc. Educate patients on their personal financial responsibility and expectation. Establish relationships with external resources to resolve billing inquiries, including Patient Financial Services, MGBS, Collection Vendor, Controller’s Office, etc. Coordinate the resolution of bad debt patient outsource accounts with collection vendor.

  • WQ Management: Monitor and manage revenue cycle related work queues in the EPIC system. Resolve issues in a proactive manner by ensuring all work queue items are reviewed, followed-up, and appropriately closed.

  • Process Improvement: Contribute to the development of new administrative processes to streamline billing workflow and improve efficiency. Update or provide systematic screenshots to develop written standard work and policies. Keep abreast of changes in government regulations and requirements of all third-party carriers. Draft changes to systems, policies, and procedures as needed. Use Epic Dashboards to monitor work queues, identify aging accounts, and prioritize follow-up tasks. Customize and filter Epic Dashboards to focus on specific work queues or account types. Leverage dashboard filters to identify overdue accounts or insurance claims requiring immediate attention. Provide backup support as needed in all areas of the PBS, assist in developing training material, and assist management with specific tasks, training, and special projects. Collaborate with Dental Center clinics, patients, and outside stakeholders to resolve billing inquiries.

Qualifications

• Required Qualifications:

  • At least 1 year of previous Insurance Follow up experience.
  • Graduation from high school or a GED and five years of experience, including two years of experience in collections investigation; or an equivalent combination of education and experience.
  • Demonstrates ability to communicate effectively (oral and written).
  • Experience with MS Excel, Word, and Outlook.
  • Effective time management and ability to meet deadlines.
  • Ability to work independently or as needed with a team.
  • Ability to meet productivity and quality standards.
  • Proven ability to coach and mentor staff for optimal results.
  • Ability to set priorities, goals, and objectives.
  • Proven ability to perform all aspects of billing and follow-up with superior quality.
  • Excellent attendance record.

• Preferred Qualifications:

  • Prior working knowledge of the EPIC (Apex) system, especially PB or HB Insurance Follow up Module(s).
  • Prior experience in a medical office environment; strongly preferred.
  • Knowledge of UC Peoplesoft.
  • Bachelor's degree in related area and/or equivalent experience/training.
  • Certified Procedure Coding (CPC), Certified Dental Coding (CDC).

About UCSF

The University of California, San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It is the only campus in the 10-campus UC system dedicated exclusively to the health sciences. We bring together the world’s leading experts in nearly every area of health. We are home to five Nobel laureates who have advanced the understanding of cancer, neurodegenerative diseases, aging, and stem cells. Pride Values: UCSF is a diverse community made of people with many skills and talents. We seek candidates whose work experience or community service has prepared them to contribute to our commitment to professionalism, respect, integrity, diversity, and excellence – also known as our PRIDE values. In addition to our PRIDE values, UCSF is committed to equity – both in how we deliver care as well as our workforce. We are committed to building a broadly diverse community, nurturing a culture that is welcoming and supportive, and engaging diverse ideas for the provision of culturally competent education, discovery, and patient care. Additional information about UCSF is available here.

Salary Information

The final salary and offer components are subject to additional approvals based on UC policy. Your placement within the salary range is dependent on a number of factors including your work experience and internal equity within this position classification at UCSF. For positions that are represented by a labor union, placement within the salary range will be guided by the rules in the collective bargaining agreement. To learn more about the benefits of working at UCSF, including total compensation, please visit: https://ucnet.universityofcalifornia.edu/compensation-and-benefits/index.html.