#139908 Patient Biller, Specialty Billing - Remote

DESCRIPTION

UC San Diego Health's Revenue Cycle department supports the organization's mission to deliver outstanding patient care and to create a healthier world — one life at a time. We are a diverse, patient-focused, high-performing team with a commitment to quality, collaboration, and continuous improvement that enables us to deliver the maximum standard of care to our patients. We offer challenging career opportunities in a fast-paced and innovative environment and we embrace individuals who demonstrate a deep passion for problem-solving and customer service.

The Patient Biller, Specialty Billing is responsible for performing hospital billing and follow up functions and related activities in support of the revenue cycle and in accordance with applicable Federal, State and local standards, guidelines and regulations. These responsibilities include but are not limited to: resolving claim edits and related errors to produce clean and accurate billing, following up on unpaid claims in an effort to determine the root cause/status of the delayed payment and for tracking/trending delay issues.

The Patient Biller, Specialty Billing is also responsible for tracking/trending and resolving denial issues for assigned payer and/or assigned service line. The Patient Biller, Specialty Billing must possess extensive knowledge in Insurance billing, including a wide range of knowledge surrounding ICD10, CPT, HCPCS and other coding principles. The Patient Biller, Specialty Billing must also possess general knowledge of medical/surgical terminology, and general knowledge of accounting and reimbursement principles. The Patient Biller, Specialty Billing must possess extensive knowledge of the field requirements related to insurance billing documents and claim forms (especially UB04 hospital billing claim form). The Patient Biller, Specialty Billing is responsible to work system generated claims, edits, record requests, resolve denial issues and credit balance accounts. Job standards are expected to be performed at an expert level. The Patient Biller, Specialty Billing may be required to provide job shadow knowledge sharing with new hires after training, during the new hire onboarding process.

MINIMUM QUALIFICATIONS

• HFMA Certified Revenue Cycle Representative (CRCR) within 120 days of hire date.

• Minimum of 4 years of current hospital billing and collection experience. Experience must include exposure to specialty billing functions such as Workers' Compensation, Chronic Dialysis, Radiation Oncology, or related specialty service lines, with a strong foundation in denial management, claim rejection trending, and AR follow-up.

• Experience with hospital billing and collections, including specialty billing, reimbursement follow up, denial and claim rejection trending and follow up.

• Experience working with hospital billing information systems.

• Demonstrated understanding of the principles of hospital billing (including UB04 field requirements, Revenue Code Requirements, NUBC standards, and so forth), knowledge of how to research payer billing requirements to promote billing compliance.

• Knowledge of medical insurance state and federal rules and regulations related to hospital billing requirements.

• Knowledge and ability to comprehend hospital billing payer contracts and reimbursement methodologies, including but limited to: per diem reimbursement, case rate, DRG, fee schedule, stop loss reimbursement.

• Demonstrated knowledge of medical terminology, CPT, ICD-10, HCPCS, and modifier codes, including impact on coverage and reimbursement.

• Demonstrated ability to apply principles and best practices of customer service and courtesy during all types of customer interactions, including in-person and telephone.

• Demonstrated ability to independently apply problem analysis and resolution principles, and situation response guidelines, to appropriately take actions and resolve hospital billing concerns with minimal direction.

• Demonstrated ability to communicate and problem-solve issues professionally and effectively with individuals at all levels of the organization. Demonstrated ability to effectively communicate and escalate unresolved hospital billing concerns to management.

• Demonstrated ability to pay attention to details and follow through independently.

• Demonstrated ability to communicate effectively – both verbally and in writing.

• Demonstrated proficiency in use of Microsoft Office applications (including Outlook, Skype/Lync, Excel, Word).

PREFERRED QUALIFICATIONS

• Hospital Medicare billing and AR follow-up experience.

• Advanced hospital dialysis billing and AR follow-up experience.

• AAPC Certified Professional Coder (CPC), or AHIMA Certified Coding Specialist (CCS), consistent with industry standards for large academic medical centers.

• Experience with specialty billing in one or more of the following areas: Workers' Compensation, Chronic/End-Stage Renal Disease (ESRD) Dialysis, Radiation Oncology, Lifesharing/Organ Acquisition, Embassy/International patient billing, or other hospital subspecialty service lines.

• Hospital Medicare and Medicaid billing with AR follow-up experience in a large academic or teaching hospital environment.

• Familiarity with Epic or other enterprise-level hospital billing information systems commonly used in academic health systems.

• Intermediate proficiency in Microsoft Excel, including pivot tables, VLOOKUPs, and data filters for AR trending and billing reporting.

• Demonstrated ability to read, interpret, and apply complex hospital billing structures, including payer contracts, reimbursement methodologies, and EOB/ERA adjudication.

SPECIAL CONDITIONS

• Must be able to work various hours and locations based on business needs.

• Employment is subject to a criminal background check and pre-employment physical.

If employed by the University of California, you will be required to comply with our Policy on Vaccination Programs, which may be amended or revised from time to time. Federal, state, or local public health directives may impose additional requirements.

If applicable, life-support certifications (BLS, NRP, ACLS, etc.) must include hands-on practice and in-person skills assessment; online-only certification is not acceptable.

UC San Diego Health is the only academic health system in the San Diego region, providing leading-edge care in patient care, biomedical research, education, and community service. Our facilities include two university hospitals, a National Cancer Institute-designated Comprehensive Cancer Center, Shiley Eye Institute, Sulpizio Cardiovascular Center, the only Burn Center in the county, and dozens of outpatient clinics. We invite you to join our team!

Applications/Resumes are accepted for current job openings only. For full consideration on any job, applications must be received prior to the initial closing date. If a job has an extended deadline, applications/resumes will be considered during the extension period; however, a job may be filled before the extended date is reached.

To foster the best possible working and learning environment, UC San Diego strives to cultivate a rich and diverse environment, inclusive and supportive of all students, faculty, staff and visitors. For more information, please visit UC San Diego Principles of Community.

The University of California is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected status under state or federal law.

For the University of California’s Anti-Discrimination Policy, please visit: https://policy.ucop.edu/doc/1001004/Anti-Discrimination

UC San Diego is a smoke and tobacco free environment. Please visit smokefree.ucsd.edu for more information.

UC San Diego Health maintains a marijuana and drug free environment. Employees may be subject to drug screening.

Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts an offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; or have filed an appeal of a finding of substantiated misconduct with a previous employer.

a. "Misconduct" means any violation of the policies governing employee conduct at the applicant’s previous place of employment, including, but not limited to, violations of policies prohibiting sexual harassment, sexual assault, or other forms of harassment, or discrimination, as defined by the employer. For reference, below are UC’s policies addressing some forms of misconduct:

• UC Sexual Violence and Sexual Harassment Policy
• UC Anti-Discrimination Policy
• Abusive Conduct in the Workplace