Hours

Shift Start Time:

Shift End Time:

Additional Shift Information:

Weekend Requirements:

On-Call Required:

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

• H.S. Diploma or Equivalent

Essential Functions

• Billing compliance
  Obtain complete and accurate demographic data, visit data, selection and follow-up questions.
  Obtains signatures on COA, CMRI letter, financial waiver, denial letters, etc.
  Dissemination all admission forms - CMRI letter, ADHC, Medi-Cal questionnaire.
  Verify demographic and insurance data, obtain authorization, and document Insurance/physician notification per department standards.
  Obtains medical record numbers per policy.
  Screens accounts and makes referrals (Medi-Cal and CMS).
  Screens all Medicare inpatient admissions for 72-hour outpatient overlap.
  Check for MCARE overlapping charges and transfers when appropriate.
  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.).
  Check DDE for Medicare eligibility.
  Review and release all necessary hold bill; final verification.
  Complies with all rules and regulations governing Medicare and Med-Cal billing.
• Contributes to the achievement of team billing goals
  Completes coverage profile on all accounts.
  Requests and collects deductibles, co-pays, deposits.
  Assures billing compliance standards are met.
  Provide financial counseling, following department policy and procedure, to secure payment on all self-pay balances.
  Releases billable accounts and series bills per department time guidelines.
• Customer service and teamwork
  Greets and makes welcome a variety of customers by the telephone and in person.
  Obtains information from visitors/callers, directs as appropriate or takes complete and accurate messages. Acts on requests for customer assistance.
  Uses scripts as appropriate including answering phones, transferring calls and service recovery.
  Responds to all inquiries with a timeliness and follow-through that promotes customer satisfaction.
  When appropriate, customer concerns, requests, billing questions, or general inquiries are addressed or resolved personally, and not forwarded.
  Communicates effectively with all levels of staff and uses chain of command.
• Department competency
  Completing all initial competencies.
  Consistently demonstrating competency as identified in the ongoing assessment and evaluation.
  Implementing and adapting the comprehensive, age/culturally appropriate plans using patient care interventions with patient and family.
• Department efficiency and effectiveness
  Prioritizes effectively, keeping supervisor informed of backlogs in completing work assignments.
  Accesses department references accordingly to assure compliance.
  Monitor all accounts in representative's assignment (IDX prod system) or alpha split for.
  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-billed status of accounts weekly, including assisting with pre-billing functions as assigned.
  Assist with supporting other roles as assigned to ensure operational efficiency such as registration functions, pre-billing work, or relief team leader.
• Professional development
  Establishing mutually derived annual goals and meets goals.
  Maintaining individual in-service/performance records.
  Demonstrating process of self-discovery including knowledge of strengths and weaknesses and view deficiencies as opportunities for growth.

Knowledge, Skills, and Abilities

• Under general supervision, utilizes excellent customer service skills when assisting customers.
• Ability to comply with all safety regulations, policies and procedures as defined by Sharp HealthCare.
• Knowledge of medical terminology, insurances, billing and collections guidelines/criteria.
• Knowledge of 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.
• Skilled in basic computer functions and basic utilization management.
• Ability to accurately type or on-line key 35-40 wpm.
• Ability to organize and prioritize work activities.
• Ability to communicate/discuss personal and financial matters with patients and/or their representatives, document effectively and concisely, communicate effectively both verbally and in writing, and function well in demanding/stressful environment.

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