Tri-City Medical.

  • Oceanside, CA


  • Long-term.

  • Full-time.

Position Summary

This position reports straight to the Patient Accounting Supervisor and is accountable for the billing of center claims to different payers both digitally and through paper submission. This position makes sure all expenses are sent day-to-day to the appropriate entity which any mistakes that might strike an edit are remedied prior to claims submission.

Essential Job Functions:

Access several billing systems everyday to make sure all tidy claims are sent to the appropriate entity for prompt payment. Those claims striking an edit should be evaluated and follow-up finished with the proper department to make sure resolution leading to tidy claim submission.

Billing

  • Reviews declares daily in several billing systems to guarantee claim precision prior to claim submission.
  • Performs BTR reconciliation when required to make sure all claims have actually dropped in the suitable system
  • Splits charges in between several lines when an absolutely no charge exists on the claim
  • Reviews the Payer matrix to guarantee claims are routed to the proper payer.
  • Ensure records are connected to the suitable claims as needed by the payer and sent out licensed mail.
  • Prior to paper claim submission guarantee proper address.
  • Obtain the suitable CMG code prior to submission of Rehab claims.
  • Ensure the right worth code exists prior to secondary claim submission
  • Review claims for invalid/missing modifiers, void variety of systems (MUE edits), void CPT code and date period mistakes along with extra edits as needed.
  • Coordinates retrieval of drug store billings for 340 B billing prior to claim submission.
  • Works electronic insurance coverage turns down daily in order to retransmit with fixed insurance coverage info/ information
  • Identify and inform accountable departments of problems relating to inaccurate CPT or ICD-10 coding and acquire proper codes from the suitable department
  • Transmits expenses digitally to all payers, evaluates all paper declares prior to submission to guarantee electronic transmission is not a choice.

Additional Duties and Responsibilities:

Cross Function

  • Works in cooperation with the collectors by examining accounts sent 30 days ago that have yet to have a payment published and/or recognition got. Will help in recording correspondence and/or pulling needed files as detailed within the correspondence.
  • Works in cooperation with the Credit Analyst by helping in the evaluation of credit balances.
  • May help in client calls along with location follow-up contacts us to insurance coverage providers.
  • Training of brand-new hires as needed to guarantee an understanding of the billing system/overall procedures

Practice Requirements

  • Ensures that client privacy is constantly safeguarded, both audible and noticeable
  • Ensures compliance with all medical practice policies, such as, however not restricted to HIPAA and OSHA

Safety and Infection Control Responsibilities

Responsible to keep a safe and tidy environment, consisting of department/unit based security and infection control requirements.

Qualifications: ESSENTIAL COMPETENCIES, KNOWLEDGE & EXPERIENCE

  • High School Diploma or GED Required
  • 3 years of Acute Care Hospital billing experience, need to consist of Medi-cal, Medicare and Commercial payers
  • Ability to carry out mathematical computations, balance and fix up figures.
  • Must have the ability to check out and compose in English.
  • Must have capability to show versatility and focus on workload.
  • Knowledge of health care payor systems and advantages (Medi-cal, Medicare, HMO, PPO, Work Comp billing standards)
  • Understanding of CPT, ICD10 and HCPCS codes
  • Demonstrated understanding of HIPAA guidelines and policies
  • Excellent oral and written interaction abilities; need to have the ability to work in a group environment.
  • Must have understanding of condition codes, worth codes and modifiers.
  • Computer abilities consisting of Microsoft Office; particularly Word, Excel and Outlook

Each brand-new hire prospect who is used work needs to pass a physical examination, urine drug screen and pre-employment background checks prior to beginning work.

Tri-City Medical.

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