Access Services Representative - Payer Focus - Full Time & Part Time Opportunities - San Diego
Sharp HealthCareSan Diego, CA, USjob_description.job_card.variable_days_ago
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job_description.job_card.job_descriptionH.S. Diploma or Equivalent Billing Completes all functions required to process billing of all hospital visits by producing a prompt, clean bill drop 4-7 days post patient discharge. All billings comply with Federal, State and local billing guidelines and criteria without exception. Participate in the achievement of team billing goals through timely release of billable accounts and release of series bills. Functions include : Complete and accurate demographic data Complete and accurate visit data Complete and accurate insurance selection and follow-up questions Verify demographic and insurance data Insurance / physician notification - documented Dissemination of admission forms - CMRI letter, ADHC, Medi-Cal questionnaire Signatures : COA, CMRI letter, financial waiver, denial letters Medical record numbers are not duplicated Screen accounts and make appropriate Medi-Cal and CMS referrals to HOS workers. Screens all Medicare inpatient admissions for 72-hour outpatient overlap Check for MCARE overlapping charges and transfers when appropriate 72-hour outpatient overlaps are used for Medicare inpatient admits Complies with all rules and regulations governing Medicare and Medi-Cal billing Any additional functions as described in Department memos or general updates, including assisting with pre-billing functions as assigned. Complete UR Screen and Coverage Profile Obtain all necessary attachments required for billing (i.e. hard copy authorizations, medical records. 18-1. 50-1. etc.). Assures billing compliance standards are met Check DDE for Medicare eligibility Review and release all necessary hold bill; final verification Scheduled patients are pre-verified and pre-authorized prior to hospital admission Urgent admissions are verified and authorized immediately or upon next business day Controllable mailbacks are less than 1% of total billing production Any additional functions as described in Department memos or general updates, including assisting with pre-billing functions as assigned. Assist with registration functions as assigned As assigned, serves as Lead in absence of Team Leader. MEASUREMENT : Random sample audits reflect a 93-97% accuracy rate. Avoidable duplicate medical record numbers are not created. Coached errors are not repeated. Work accounts within 2-3 days of assignment to worklist. 2-3 exceptions per year meet standard. No potentially fraudulent claims are submitted. Complies with all Local, State and Federal guidelines Complies with all Local, State and Federal guidelines governing Department operations as well as all SDHA and Department memos, guidelines, policies and procedures. Takes responsibility for policy and procedure knowledge. Accesses Department references accordingly to assure compliance. MEASUREMENT : Knowledge of identification of non-compliance reported to management immediately. No formal corrective action meets standard. Customer service Demonstrates a positive, caring attitude to all customers by providing prompt, courteous, and competent assistance in both personal and telephone interactions. Greets customers in a cheerful helpful, professional manner. Strives to assure customer satisfaction with encounter. Assure proper handling of all written correspondence, physician orders, and / or electronic mail. When appropriate, customer concerns, requests, billing questions or general inquiries are addressed or resolved personally, and not forwarded. Management is advised of all unusual, significant encounters. MEASUREMENT : No more than 2-3 valid observed or documented exceptions per year meets / meets & exceeds standard. Department production Contributes proportionately to Department production. Offers to assist others and asks for assistance in completion of assignments, as needed. Prioritizes effectively, keeps management informed of backlogs and promotes a team approach in completion of job duties. Downtime is used productively. Monitor all accounts in rep assignment or alpha split. Contact hospital departments such as Medical Records, Utilization Review or external review organizations to resolve any billing or authorization delays. Provide Team Leader with non-final billed Status of accounts weekly. MEASUREMENT : Maintenance of work list performed daily. 2-3 exceptions per year meets standard. Accounts do not exceed 7 days in DNFB without evidence of follow-up activities. Payment processing Complete coverage profile on all accounts. Request and collect deductibles, co-pays, deposits. Provide financial counseling, following Department policy and procedure, to secure payment on all self-pay balances. MEASUREMENT : 45% of all patient cash collected is collected at hospital site meets standard. 95-100% of all applicable accounts have completed coverage profile. Professional development Accepts instruction, coaching. and counseling in a positive productive manner. Identifies own need for skill development and pursues training opportunities. MEASUREMENT : Feedback is accepted constructively and a participative action plan is created when necessary to meet standard Teamwork Demonstrates teamwork and cooperation through positive and supportive communication regarding Department changes, goals, policies and procedures. Promotes a positive work environment by respecting others, being honest, fair, and consistent. Takes responsibility for Department morale, and involves management accordingly when issues that affect morale arise. Asks necessary questions regarding new ideas or changes to facilitate a positive reaction and support for innovation. Brings an uplifting, positive approach to work assignments. Accepts interpersonal differences and cooperates with other employees. Accepts responsibility for own actions, personal growth, and development. Attends and participates in regularly scheduled staff meetings and training. MEASUREMENT : Supervisor observations, monitoring of intake forms and IDX Adjustment Reports indicate no deviation from Department policy without valid supporting documentation on account. 2-3 exceptions per year will meet standard. No more than 5-6 exceptions for meeting attendance per year meets standard. Medical terminology. Insurances, billing and collections guideline / criteria. Local, State, and Federal regulations governing registration / billing activities including JCAHO, Title XXII, Medicare and Medi-Cal regulations. ICD-9, RVS and CPT 4 coding. Basic computer functions. Basic utilization management. Accurately type or on-line key 35-40 wpm. Organize and prioritize work activities. Communicate / discuss personal and financial matters with patients and / or their representatives. Document effectively and concisely. Communicate effectively both verbally and in writing. Function well in demanding / stressful environments.
Billing Specialist
The stated pay scale reflects the range that Sharp reasonably expects to pay for this position. The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant's years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.
What You Will Do
Obtains and verifies patient demographic, visit, and financial information in a manner that facilitates maximum financial reimbursement and promotes premier customer service.
Required Qualifications
- 2 Years Experience in the Business Services setting with demonstrated above-standard performance in billing, account follow-up, and at least one other area of expertise
Preferred Qualifications
Essential Functions
Knowledge, Skills, and Abilities
Sharp HealthCare is an equal opportunity / affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class.
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Representative Focus • San Diego, CA, US
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