Patient Rep Biller

Claims Reviewer

Position Summary: To review claims for accuracy of information, expedite billings to all third party payers and patients, and when applicable, call to identify billing address. Enhances professional growth and development through the participation in educational programs, staff meetings, in-services/workshops and successful completion and maintenance of required certifications of specialty areas. Demonstrates the ability to determine the accuracy of pertinent medical, coding, eligibility, authorization, demographic and financial information, and institute any required corrections. Determines payer documentation requirements for payment, and insures that they are available to be submitted with the claim. Transmits/submits clean claims to payers, within three working days of receipt. Updates computer system to reflect submission/transmission of claims. Reviews correspondence submitted by the payer, and provides correction and/or documentation within three working days. Reviews payment data for suspension, underpayment, and denials and submits appropriate response. Reviews bi-monthly accounts receivable reports to identify claims which have been submitted and either not resolved or acknowledged, and claims which have not been submitted. Takes appropriate action to insure resolution. Prepares adjustments required to insure that balances reflect payable amounts, and forwards to management for review and authorization. Demonstrates a complete understanding of department equipment and proper usage. Promotes customer service through active communication, understanding their needs and concerns and providing resolution with tact, diplomacy and sensitivity. Contributes to the team effort by remaining flexible and open minded, maintaining cooperative working relationships, sharing resources and information, and assisting co-workers in time of need. Actively keeps up to date with developments in the industry by reading material provided by payers and/or management, attending seminars and using contacts in the industry. Demonstrates the ability to make sound, productive and ethical decisions in the performance of assigned duties. Demonstrates a commitment to quality and excellence. Complies with departmental and hospital policies and procedures. Reports to work on time and is at work station ready to begin work at the scheduled start time. Attendance is within standard. Maintains confidentiality of department and medical center information. Exhibits appropriate telephone/fax/beeper protocol, i.e. answers promptly, identifies name and department and is courteous and helpful, and has knowledge of commonly used extensions. Incorporates medical center's mission of "quality care with compassion and respect" into daily performance of job functions. Takes into consideration the age specific needs of the geriatric patient assuring communications are understood, repeats and questions comments as well as any special physical needs. All other duties as assigned.

Minimum Education: High School diploma.

Minimum Work Experience and Qualifications: Ability to communicate effectively verbally and in writing. Three years billing experience in a hospital setting or five (5) years of relevant hospital experience. Knowledge of payer requirements and medical terminology 30 wpm typing and the ability to operate all department equipment and software programs

Required Licensure, Certification, Registration or Designation: Current Los Angeles County Fire Card (or must be obtained within 30 days of hire) Assault Response Competency (ARC) required (within 30 days of hire)

Full-Time, Days