Billing Specialist

Billing Specialist

Location: Valencia, CA 91355 Patient Financial Services department (location is off site from the hospital campus, 10 minutes away)

Duration: 13 Weeks

Shift: 1st Shift Day || Monday through Friday || 8:00 AM to 4:30 PM, with a 30-minute lunch break

Position Summary:

• We are seeking a reliable and motivated Billing Representative for a fast-paced, multi-specialty professional physician-based practice. This role requires someone who is comfortable wearing multiple hats and handling a variety of responsibilities as assigned.
• The ideal candidate is a fast learner, a team player, and a self-starter with a strong work ethic. They should be able to work independently without the need for close supervision and demonstrate initiative in completing tasks.
• Candidates must have comprehensive knowledge of all aspects of professional physician billing. Responsibilities include reviewing medical billing systems to verify patient balances, answering phones, scanning documents, and supporting accounts receivable processes such as claim receipt confirmation. If the candidate is a fast learner, they may also assist with payment posting.
• Under the direct supervision of the Manager, the Billing/Collections representative is responsible for the billing and collecting of all professional claims, in accordance with state and federal regulations and client's policies. Compiles and maintains records for services rendered and ensures accurate entries; assists in processing claims for timely reimbursement.

Essential Position Duties and Responsibilities

• Demonstrates behaviors that reflect the Hospitals Core Values of Quality, Safety, Teamwork, Accountability, Integrity and Respect.
• Adheres to Client's Compliance Policies and Procedures and reports all suspected violations of legal or regulatory statutes through appropriate channels.
• Demonstrates knowledge, skill and ability to provide care/service based on the specific patient population. Demonstrates, modifies and adapts work behavior in meeting the patients specific needs and/or providing the services required.
• Demonstrates the ability to focus on the specific needs of the patient population and provide the care or service needed.
• Demonstrates appropriate communication skills for the patient population served.
• Files and enters charges into system and analyzes patient accounts as directed by supervisor and per supporting documentation.
• Applies appropriate and accurate modifiers on claim forms; including CPT/HCPCS, ICD10, CCI edits.
• Performs third party software downloads to review CCI edits for errors; and ensures medical documentation and physician charges support billing to third party.
• Assure all government compliance standards for billing & charging (DOS, multiple task modifiers) are reviewed and applied accurately, including CWF review for Medicare Advantage and CWF open cases.
• Post payments, appeal claims, and resolves routine patient inquiries and problems.
• Submission of accurate electronic billing, and update patient demographic information, as needed.
• Meets established productivity standards established by Manager.
• Evaluates late charges to be written off, and/or send applicable late charges to be re-billed, and determines appropriate disposition based on client's policies.
• Reviews insurance correspondence received by mail and takes corrective action.
• Identifies billing and collections issues for patterns or themes and works to identify root causes for corrections.
• Performs other duties as assigned.

Quality Improvement:

• Contributes ideas, suggestions and solutions to continuously improve processes, procedures, methods and productivity.
• Maintains confidentiality, security and integrity of all health information. Follows HIPAA guidelines for patient privacy.
• Cooperates fully in all risk management activities and investigations.
• Demonstrates knowledge of, observes and complies with hospital Patient Safety Program and plan.
• Demonstrates knowledge of, observes and complies with hospital safety, infection prevention and control policies/procedures and the use of personal protective equipment.

Knowledge and Skills:

• Computer experiences mandatory.
• Knowledge of all third party reimbursement issues and/or updates related to billing government, and commercial claims
• Knowledge of medical terminology, CPT, ICD10
• Competent in billing compliance.
• Ability to accept and adapt to change easily.
• Ability to communicate verbally and in writing, to be a self-starter, and demonstrate a pleasant voice and good public relations while performing duties.
• HMO/PPO knowledge required.

Experience:

• 3-year minimum experience with professional billing in a hospital, medical, and/or health care environment.