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Billing/Claims Representative
Ref No.: 18-12730
Location: Emeryville, California
Start Date / End Date: 10/29/2018 to 06/30/2019

JOB SUMMARY
 
 
The Billing/Claims Unit is responsible for billing hard copy claims and working in the Claims Edit Work queues and follow-up on return mail.  The unit deals regularly with complex policy and procedural issues that involve contract compliance with regard to HMO and PPO payers.  It is the unit’s responsibility to communicate and coordinate throughout various UCSF Medical Center departments, including the UCSF billing agents to ensure the quality of the university’s billing process. 
 
 
 
Within this unit, the Billing/Claims Representative is responsible for the timely submission of hard copy claims as well as gathers all forms and information required for primary and secondary billing.  The incumbent reviews claims for general accuracy and completeness.  The incumbent demonstrates the ability to perform all aspect of billing with quality.  The incumbent will also conform to all UCSF, MGBS, government and HIPAA policies and procedures.
 
 
 
The understanding and working knowledge of the UCSF clients, as well as the government payers in an ever-changing environment is a challenge.  The government rules and regulations are very stringent and we must adhere to them as well as interpret them for the departments and providers.  The compliance aspect of billing and follow-up while continuing to achieve the highest reimbursement rate possible is complicated.
 
 
 
A Billing Representative has the ultimate responsibility to involve in-depth review and analyze of patient accounts so that each charge can be accurately and timely posted.  As a unit, we strive to improve our analytical skills and understanding of complex healthcare related procedures. In addition, we are flexible and adaptable to the change in computing systems
 
 
 
 
  •  
%
of time
Essential Function (Yes/No)   
Key Responsibilities
(To be completed by Supervisor)
60 YES
  • Secure all forms and pertinent information required for billing.  This may include, but is not limited to medical records, Explanation of Benefits (EOBs), departmental reports and other information as required.
  • Scan for accuracy of any billing deficiencies (i.e. diagnosis codes, procedure codes, CMS 1500 field errors, billing addresses, and other information as required.
  • Clear billing edits in a complaint manner.
 
 
20 YES
  • Adheres to the rules and regulations of the different types of payers such as PPO, EPO, HMO, and commercial insurance.
  • Initiate Charge Correction request.
  • Effectively communicate with payers, patients, UCSF departments and outside billing agents.
  • Utilize knowledge of various systems including, but not limited to:  Government and/or Non-Government websites, and any other information systems which would be required for insurance eligibility, benefit verification or other information needed to bill insurances.
  • Billing or rebilling of corrected claims.
 
20 YES
  • Sort hardcopy bills stratified by payer and/or representative assignment.
  • Review bills for general accuracy and completeness.
  • Submit bills to payers in a timely manner in accordance with department and payer requirements.
  • Secure all forms and pertinent information required for billing.  This may include, but is not limited to medical records, Explanation of Benefits (EOBs), Remittance Advice (RAs), Coordination of Benefits (COB) information, departmental reports, authorizations/pre-certifications, Treatment Authorization Request (TARs), and other information as required.
  • Initiate Charge Correction request.
  • Effectively communicate with MGBS staff.
  • Utilize knowledge of various systems including, but not limited to:
    • Microsoft Word, Excel, APEX and other system needed during billing.
  • Notify manager of possible procedural change for improving efficiency.
  • Attend department, unit and other meetings as required.
  • Billing or rebilling of corrected claims.
  • Perform other duties as assigned.
 
100%   (To update total %, enter the amount of time in whole numbers (without the % symbol - e.g., 15, 20) then highlight the total sum (e.g., 1%) at the bottom of the column and press F9. The total sum should add up to 100%.)
  •   
     
     
    REQUIRED QUALIFICATIONS
     
     
    ◦This position requires flexibility to orient and work at all UCSF Medical Center locations.
    ◦Ability to work in a changing environment and handle multiple tasks efficiently
    ◦Good organizational interpersonal, verbal and written communication skills
    ◦Knowledge of computer operations (i.e. typing, Microsoft Word, Excel)
    ◦Ability to work independently
    ◦One to Two years of experience in a professional fee billing office or related health-care experience.
     
     
     
     
     
    PREFERRED QUALIFICATION
     
    Please list:
    ◦Knowledge of CPT and ICD-9, ICD.10 Coding
    ◦Solid understanding of billing requirements of each major payor
    ◦Medical terminology experience