DESCRIPTION

UC 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 Insurance & Patient Biller III is responsible for the full range of billing duties within the revenue cycle from claim generation to final payment disposition. The Insurance & Patient Biller III will monitor, prioritize and ensure assigned work for the billing of claims, resolution of edits, attaching of records and all actions required to resolve open A/R are being addressed in a timely manner and in accordance with current departmental standards and performance metrics. The Insurance & Patient Biller III works closely with internal customers and external business partners to take any and all assigned actions required to ensure the accurate and timely billing/resolution of claims for our patients.

MINIMUM QUALIFICATIONS

• Medical Terminology training and/or certificate or equivalent experience.

• Minimum of three (3) years of medical claims billing, denial mitigation and appeals.

• Must have extensive knowledge in Insurance claims appeals, and range of knowledge in ICD-10, CPT, and HCPCS coding principles.

• Must have knowledge of CMS 1500 claims rules as it pertains to physician billing.

• Extensive knowledge of medical insurance billing/processes, billing documents, claim forms, HIPAA, PHI, and a thorough understanding of state and federal rules for billing and appealing medical claims.

• Strong proficiency with MS Office Products (Mail, Excel and Word). Ability to type at least 30 wpm.

• Ability to be able to read/understand insurance EOBs, Correspondence and other payer communications in order to resolve outstanding bills.

• Customer focused mindset. Detail-oriented, organized, and possesses excellent written and verbal communication skills.

PREFERRED QUALIFICATIONS

• Some college coursework or an Associate Degree.
• Prior Epic experience with Resolute Professional Billing.
• Billing Certificate.
• Three (3) years of recent experience specifically related to processing and resolving claims within a medical billing environment.
• Familiar with reading medical records in order to submit records to support medical necessity based on diagnosis and services rendered.
• Clear understanding or know how to properly obtain the different types of payer information timely and how to prioritize workload based on the payer specific info.
• Capable and comfortable with verifying patient coverage/insurance verification and adjudication via a payer portal, Epic system or by phone.

SPECIAL CONDITIONS

• 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.