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 Financial Services (PFS) Senior Billing and Follow Up Representative 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 PFS Sr. Biller is also responsible for tracking/trending and resolving denial issues for assigned payer and/or assigned service line. The PFS Sr. Biller must possess extensive knowledge in Insurance billing, including a wide range of knowledge surrounding ICD10, CPT, HCPCS and other coding principles. The PFS Sr. Biller must also possess general knowledge of medical/surgical terminology, and general knowledge of accounting and reimbursement principles. The PFS Sr. Biller must possess extensive knowledge of the field requirements related to insurance billing documents and claim forms (especially UB04 hospital billing claim form). The PFS Sr. Biller 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 PFS Sr. Biller/Follow up Rep may be required to provide job shadow knowledge sharing with new hires after training, during the new hire onboarding process.

• HFMA Certified Revenue Cycle Representative (CRCR) within 6 months of hire date.

• Minimum of 4 years of hospital billing and collection experience. Experience must include hospital billing and follow up, including knowledge of billing regulations (government and/or commercial payer billing requirements), as well as knowledge of reimbursement/collections protocols. Experience may be substituted with 4 year degree/education and 1 year experience in a hospital billing environment.

• 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)

• Hospital Medicare billing and AR follow-up experience.

• Advanced hospital dialysis billing and AR follow up experience.

• 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.