PFS HB Specialist 3

Pat Biller 3

#CA-KN Ensure timely and accurate billing and processing of facility claims, to include edit resolution, patient demographic analysis and correction, authorization/referral review and claim attachments. Review and correction of claim edits, DNB's and Stop Bills from various locations including reports, dashboards and work queues. Follow-up on claims with Commercial and Government payors to ensure maximum reimbursement based on payor contracts and/or regulations.

Minimum Qualifications - For full consideration, applicants are encouraged to upload license and/or certification if required of the position High School Diploma or GED equivalency. Previous billing experience in a health care environment. Billing and Collections experience. Experience analyzing and interpreting various payor contracts and government payer regulations to ensure compliance with the terms and conditions of the contract and/or regulations. High attention to details; Ability to bill clean Hospital claims while maintaining quality and productivity expectations. Ability to use computer technology effectively to perform all work functions as well as to navigate through the internet or other software (e.g. DDE) to obtain eligibility and/or make demographic updates as indicated. Independent decision-making skills to determine appropriate course of action in billing accounts. Ability to read and interpret information sufficient to understand memos, manuals and bulletins regarding complex billing and follow-up procedures. Mathematical skills to audit accounts and calculate expected reimbursement/underpayments Ability to multi-task, set priorities, work accurately and quickly under pressure in order to meet deadlines set by the department, government programs, or private insurance carriers. Ability to react with flexibility and patience and maintain efficiency and accuracy under sustained and immediate pressure created by heavy workload, frequent interruptions and multiple, sometimes competing, requests. Knowledge of Government and other third-party payer program requirements, billing codes, coding systems and medical terminology. Ability to interpret payments, correspondence and denials from insurance companies, agencies and other departments. Ability to compose and use spreadsheets to calculate complex reimbursement. Ability to establish a good rapport and professional working relationship with all departmental personnel, management and outside parties. Maintains appropriate interdepartmental communications. Demonstrates professionalism, tact, courtesy and diplomacy in dealing with personnel at all levels in and outside of the health system; utilizes effective listening and questioning techniques. Knowledge of the Epic billing and clinical modules in order to research and adjust accounts. Maintain confidentiality and adhere to the Code of Conduct and Principals of Community standards Knowledge of, and demonstrated skill with various spreadsheet and software applications including Microsoft Excel and Word, Clearinghouse, Contract Management and Patient Accounting Systems. Experience in health care receivables management is preferred, ideally in an academic teaching hospital environment, working with government and commercial payers and contracts. Ability to tactfully, clearly and effectively communicate and convey complex information by phone, in writing or in person and to effectively elicit and receive information from individuals, companies, agencies and other departments. Adaptability and flexibility to accommodate changes in policies, procedures and management. Adherence of UCD/UCDH methods, policies and procedures.

Preferred Qualifications Epic billing experience preferred. Experience with using electronic medical records system. Academic institution or large integrated health system experience. Knowledge of coding systems preferred

Key Responsibilities 30% - Billing/Rebilling Complex Accounts 25% - Auditing/Adjusting/Reconciliation 20% - Research 15% - Denials/Appeal/Payor Requests 10% - Special Projects/Misc

Department Overview Patient Financial Services (PFS) manages revenue cycle functions including DNFB, billing, contract management, insurance follow-up, charge audit, denials, underpayments as well as internal operational and functional reporting and support related to hospital/facility billing. PFS ensures account information contains accurate and comprehensive data to provide timely billing and optimal reimbursement for services rendered. PFS impacts processes to include charge capture, coding, insurance identification, data/charge entry, registration, authorizations, billing, payment posting, refund processing and collections.

POSITION INFORMATION Salary or Pay Range: $28.90 - $35.92 Salary Frequency: Hourly Salary Grade: 101 UC Job Title: PAT BILLER 3 UC Job Code: 004663 Number of Positions: 1 Appointment Type: Staff: Career Percentage of Time: 100 % Shift (Work Schedule): 8 hours, Monday-Friday Location: UCDHAS Building (HSP165) Union Representation: EX-Patient Care Technical Benefits Eligible: Yes