Patient Account Rep Prof Billing - FT - Days - Physician Services

Unit Specific Duties

Billing

• Ensures claims are billed timely and accurately using the Hospital Claims Scrubber Tool and billing system.
• Solves 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.
• Solves patient billing inquiries and processes patient payments over the phone or in person.
• 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.

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.

Qualifications

• High School Diploma or equivalent.
• One year 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.
• Able to multi-task and demonstrate effective time management.
• Preferred knowledge and use of Microsoft Products: Outlook, Word & Excel.
• Strong attention to detail.
• Able 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

• $33.75 - $50.63 USD Hour

The Physical Requirements and Working Conditions of this job are available.

El Camino Health will provide reasonable accommodations to qualified individuals with a disability if that will allow them to perform the essential functions of a job unless doing so creates an undue hardship for the hospital, or causes a direct threat to these individuals or others in the workplace which cannot be eliminated by reasonable accommodation.

Sedentary Work - Duties performed mostly while sitting; walking and standing at times. Occasionally lift or carry up to 10 lbs. Uses hands and fingers.

El Camino Health seeks and values a diverse workforce. The organization is an equal opportunity employer and makes employment decisions on the basis of qualifications and competencies. El Camino Health prohibits discrimination in employment based on race, ancestry, national origin, color, sex, sexual orientation, gender identity, religion, disability, marital status, age, medical condition or any other status protected by law. In addition to state and federal law, El Camino Health also follows all applicable fair and equitable employment policies from the County of Santa Clara.