Transplant Billing & Follow Up Rep - Hybrid - 136611

UCSD Layoff from Career Appointment : Apply by 09 / 10 / 25 for consideration with preference for rehire. All layoff applicants should contact their Employment Advisor.

Special Selection Applicants : Apply by 09 / 19 / 25. Eligible Special Selection clients should contact their Disability Counselor for assistance.

This position will work a hybrid schedule which includes a combination of working both onsite at Greenwich Drive (San Diego, CA) and remote. Onsite 3 days a week.

This position will remain open until filled.

DESCRIPTION

UC San Diego Health is seeking a skilled and motivated Billing & Collections Representative to join our large-scale hospital billing operations team. This role focuses on Solid Organ Transplant, Bone Marrow Transplant (BMT), and CAR T billing and follow-up, one of the most specialized and complex areas of hospital revenue cycle. The successful candidate will demonstrate strong billing and collections expertise, attention to detail, and the ability to work claims from start to finish across government and commercial payors.

Key Responsibilities :

• Process Hospital Billing (HB) and Professional Billing (PB) claims for Solid Organ, BMT, and CAR T services across pre-, intra-, and post-transplant phases.
• Prepare and submit clean claims with all required documentation, ensuring accurate account linking and transplant bundle billing.
• Conduct account follow-up and collections : monitor outstanding balances, resolve denials, submit appeals, and escalate unresolved claims as needed.
• Review account trial balances (ATBs), hospital account records (HARs), and authorizations in Epic to ensure billing compliance.
• Collaborate with internal teams including Authorization, Financial Coordinators, and Revenue Integrity to resolve issues and secure payment.
• Maintain compliance with payer rules, state / federal regulations, and UC San Diego Health policies.

Key Skills :

MINIMUM QUALIFICATIONS

Three (3) years of recent acute care hospital billing and collection experience.

Knowledge of medical insurance and State and Federal rules and regulations related to billing Insurance Claims.

Extensive knowledge in Insurance claims appeals, and range of knowledge in ICD-10, CPT, HCPCS coding principles.

Knowledge in self-pay collections.

Knowledge of UB04 and revenue codes as it pertains to billing.

PREFERRED QUALIFICATIONS

Certification in billing / coding (e.g., CPC, CPB, HB).

Strong working knowledge of Epic billing systems (HAR, ATB, Auth / Cert).

Experience with government and commercial payors.

Proven ability to resolve complex denials and secure payments on high-dollar accounts.

Prior transplant billing experience (Solid Organ, BMT, CAR T) in an academic medical center or large hospital system.

Knowledge of transplant billing phases :

Pre-Transplant : evaluation, testing, clearance, and how services are reimbursed or bundled.

Experience managing single-bundle and two-part bundle claims

Familiarity with payer transplant networks and agreements across government and commercial payors

Ability to review and prepare Billing Summaries, Itemized Statements, Organ Acquisition and Perfusion Invoices, and ensure proper inclusion / exclusion of services.

Experience collaborating with Transplant Financial Coordinators (TFCs), Central Authorization Teams (CATs), and clinical staff to align financial clearance, authorizations, and claim submissions.

Strong understanding of Epic billing functionality related to transplant (HAR, ATB, Auth / Cert, EOC linking).

Demonstrated success in appeals and follow-up for high-dollar, complex transplant claims.

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.

Pay Transparency Act

Annual Full Pay Range : $61,116 - $75,982 (will be prorated if the appointment percentage is less than 100%)

Hourly Equivalent : $29.27 - $36.39

Factors in determining the appropriate compensation for a role include experience, skills, knowledge, abilities, education, licensure and certifications, and other business and organizational needs. The Hiring Pay Scale referenced in the job posting is the budgeted salary or hourly range that the University reasonably expects to pay for this position. The Annual Full Pay Range may be broader than what the University anticipates to pay for this position, based on internal equity, budget, and collective bargaining agreements (when applicable).