Billing & Collections Representative II - PFS - RCSSD

JOB SUMMARY:

Under the direction of the Manager Professional Billing & Coding, the Billing & Collections Representative II (BCII) is responsible for the resolution of all outstanding balances from all payors, including but not limited to; Commercial, Medi-Cal and Managed Care professional claims. This position is responsible checking status of unpaid claims by telephone, websites and/or any other means available in an efficient and timely manner. BCII is expected to provide all necessary documentation required from payors to ensure accurate adjudication of claim for reimbursement. They will process claims correctly following contractual arrangements the Medical Practice Foundation (MPF) has with each Payor. This incumbent is expected to accurately analyze each denial received by reviewing the patient acct, the remittance codes from Explanation of Benefits (EOB) and Remittance Advice (RA). As well, they are to review CCI or payor specific coding edits and take necessary steps to send a corrected claim or appeal to payor for reprocessing of claim to overturn denial. They are to report all problematic payor trends to leadership with specific examples. If BCII has exhausted all efforts with payor to resolve a denial following our guidelines, they will

forward claim on to leadership for further review and or appropriate resolution of claim. Incumbent is responsible for daily processing of assigned work queues following standards established by Leadership. Selection of activities and documentation on each account in the patient financial record will be completed in accordance with guidelines. BCII will review payor/clearing house rejections and making necessary corrections to ensure claim will be adjudicated. Incumbent is expected to follow federal, state, and local regulatory collection guidelines as well as department and payor specific billing guidelines.

Skills Required:

• Strong verbal and written communicator

• Problem-solver

• Master negotiator

• Emotional Intelligence

• Attention to detail

MINIMUM QUALIFICATIONS:

H.S. Diploma,GED,or Equivalent

2 Years of Experience

Must possess some medical billing experience.

A certificate of completion from a medical billing course can be substituted for 1 year of experience

PREFERRED QUALIFICATIONS:

3 Years of Experience

EPIC experience a plus

The current salary range for this position is $23.10 to $31.77

Rady Children’s Hospital is committed to compensation that is externally competitive and internally equitable. We demonstrate this commitment by conducting regular market reviews to remain competitive with organizations of similar size in the nonprofit, healthcare sector. The range listed above does not represent the full salary range for the position but is the expected hiring range for qualified candidates. Compensation decisions consider a variety of factors including experience, education, licensure, unique skillsets, organizational need, and internal equity. This posting will remain open from the “date posted” until the hiring manager has determined there is a sufficient applicant pool or until the position is filled.

EOE including disability/vet