PAR-BILLING REPRESENTATIVE
Company: Tri-City Medical Center
Location: Oceanside
Posted on: May 13, 2022
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Job Description:
US-CA-OceansideTri-City Healthcare District has been serving the
North County region for almost 60 years and remains committed to
providing high quality healthcare and community services for every
individual we encounter regardless of race, color, ethnicity,
gender, sexual orientation, disability or socioeconomic status.Our
mission is to advance the health and wellness of the community we
serve. In order to achieve our mission, we see, hear and listen to
our front line healthcare workers, employees, medical staff and all
community stakeholders in order to understand and meet our
community's needs.Position Summary:This position reports directly
to the Patient Accounting Supervisor and is responsible for the
billing of facility claims to various payers both electronically
and via paper submission. This position ensures all bills are
submitted daily to the correct entity and that any errors that may
hit an edit are corrected prior to claims submission. Access
multiple billing systems daily to ensure all clean claims are
submitted to the correct entity for timely payment. Those claims
hitting an edit must be reviewed and follow-up done with the
appropriate department to ensure resolution resulting in clean
claim submission.Major Position Responsibilities: The position
characteristics reflect the most important duties, responsibilities
and competencies considered necessary to perform the essential
functions of the job in a fully competent manner. They should not
be considered as a detailed description of all the work
requirements of the position. The characteristics of the position
and standards of performance may be changed by TCMC with or without
prior notice based on the needs of the organization.+ Maintains a
safe, clean working environment, including unit based safety and
infection control requirements.+ Billing+ Reviews claims daily in
multiple billing systems to ensure claim accuracy prior to claim
submission.+ Performs BTR reconciliation when necessary to ensure
all claims have dropped in the appropriate system+ Splits charges
between multiple lines when a zero charge is present on the claim+
Reviews the Payer matrix to ensure claims are routed to the
appropriate payer.+ Ensure records are attached to the appropriate
claims as required by the payer and sent certified mail. + Prior to
paper claim submission ensure appropriate address. + Obtain the
appropriate CMG code prior to submission of Rehab claims.+ Ensure
the correct value code is present prior to secondary claim
submission+ Review claims for invalid/missing modifiers, invalid
number of units (MUE edits), invalid CPT code and date span errors
as well as additional edits as required. + Coordinates retrieval of
pharmacy invoices for 340B billing prior to claim submission.+
Works electronic insurance rejects daily in order to retransmit
with corrected insurance information / data+ Identify and notify
responsible departments of issues pertaining to incorrect CPT or
ICD-10 coding and obtain correct codes from the appropriate
department+ Transmits bills electronically to all payers, reviews
all paper claims prior to submission to ensure electronic
transmission is not an option.+ Cross Function+ Works in
collaboration with the collectors by reviewing accounts submitted
30+ days ago that have yet to have a payment posted and/or
acknowledgement received. Also, will assist in documenting
correspondence and/or pulling required documents as outlined within
the correspondence.+ Works in collaboration with the Credit Analyst
by assisting in the review of credit balances.+ May assist in
patient calls as well as place follow-up calls to insurance
carriers. + Training of new hires as necessary to ensure an
understanding of the billing system/overall processes+ Practice
Requirements+ Ensures that patient confidentiality is always
protected, both audible and visible+ Ensures compliance with all
medical practice regulations, such as, but not limited to HIPAA and
OSHA Qualifications: + 3+ years of Acute Care Hospital billing
experience, must include Medi-cal, Medicare and Commercial payers+
Ability to perform mathematical calculations, balance and reconcile
figures.+ Must be able to read and write in English.+ Must have
ability to demonstrate flexibility and prioritize work load.+
Knowledge of healthcare payor systems and benefits (Medi-cal,
Medicare, HMO, PPO, Work Comp billing guidelines)+ Understanding of
CPT, ICD10 and HCPCS codes+ Demonstrated knowledge of HIPAA rules
and regulations+ Excellent oral and written communication skills;
must be able to function in a team environment. + Must possess
knowledge of condition codes, value codes and modifiers.+ Computer
skills including Microsoft Office; especially Word, Excel and
OutlookEducation:+ High School Diploma or GED, required. Each new
hire candidate who is offered employment must pass a physical
evaluation, urine drug screen and pre-employment background checks
before starting work.**To protect the health of patients and staff,
and to comply with the new State of California mandates, all job
offers are contingent on the successful engagement in the TCMC
COVID-19 vaccination program (fully vaccinated with documented
proof or approved exception/deferral.)**TCHD is an equal
opportunity employer. All qualified applicants will receive
consideration for employment without regard to race, religion,
color, national origin, sex (including pregnancy, sexual
orientation, or gender identity/expression), age, marital status,
status as a protected veteran, among other things, or status as a
qualified individual with a disability.Req No: 2022-10756 Shift:
Day Work Schedule: 8:00-4:30 External Company Name: Tri City
Healthcare District External Company URL:
http://www.tricitymed.org/ Cost Center/Dept: 8532 - Patient
Accounting
Keywords: Tri-City Medical Center, Oceanside , PAR-BILLING REPRESENTATIVE, Accounting, Auditing , Oceanside, California
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