Weekend Eob Jobs (NOW HIRING)

Position Summary:

The Call Processing Reimbursement Specialist II is responsible for the complete revenue cycle including billing medical, dental and/or hospital claims, and working directly with members over the phone. They are responsible for the follow-up performed on insurance balances to ensure accurate reimbursement and received in a timely manner. They are also responsible for self-pay collections and answering billing-related questions.

Essential Functions of the Job:

• Efficiently and actively provides excellent customer service by properly greeting, listening, assisting, directing, and closing each call
• Log in and be ready to receive or make calls as directed by schedule as well as utilizing break codes appropriately as defined by the call management system
• Demonstrates knowledge and understanding of the services provided and programs offered to answer questions and direct calls appropriately
• Review, collect and update patient demographics and take appropriate actions to update identified changes
• Must be well versed and up to date in all billing rules and regulations to ensure compliance with federal and state laws
• Ensures accurate calculation of disallowances and adjustments through analysis of SYHealth contracts, Medicare and Medi-Cal reimbursement schedules and rates
• The ability to read and interpret contract language is an essential function of the Call Processing Reimbursement Specialist II
• Documents all analysis findings, phone calls and correspondence in the online practice management system
• Prepares accounts and encounters for accuracy for billing; Prepare, review, and transmit claims using automated systems and manual paper claim process
• Understands, recognizes, and effectively handles unique medical issues, urgent services and patient grievances and follows established protocols to resolve problems or determines escalation to supervisor
• Must maintain assigned Accounts Receivable at or below goal on a consistent basis
• The Call Processing Reimbursement Specialist II provides quality, efficient telephone customer service to internal and external customers and route calls to appropriate department for continued assistance as necessary
• Responds to all patient or insurance inquiries timely to ensure reimbursement
• Changes system financial settings once primary insurance has paid to ensure that co-payments and deductibles are generated to guarantors
• Provides any required attachments to third party claims including authorizations and EOB'S to ensure timely payment for the third-party payer
• Performs timely follow up and appeals on unpaid claims using the system work list and or Remittance Advices, EOBs, and other payment documents
• Identify and bill secondary payers
• After obtaining any needed approval, performs adjustment write off(s)
• Functions as a resource on assigned Accounts Receivables to all staff and may assist with training
• Attends meeting and training classes as required by departmental or facility management
• Will be called upon to perform special projects and participate in internal and external audits that may require some evening and weekend hours
• Adheres to established departmental and facility policy and procedures, objectives, quality assurance programs, safety, and infection control standards

Additional Duties and Responsibilities:

• All duties as assigned by the Director of Revenue Cycle, Business Office Manager or Billing Supervisors

Job Requirements

Experience Required:

• Minimum of 3 years’ experience in a medical billing department
• Must also demonstrate knowledge of CPT, HCPCs, and ICD-10 coding as well as Medical Terminology

Education Required:

• High School Diploma or GED equivalent

Certifications Preferred:

• Certificate of completion of Billing and/or Coding

Verbal and Written Skills Required to Perform the Job:

• Good oral and written communication skills
• Provides positive customer service skills
• Must possess the ability to communicate effectively in English & Spanish; both verbally and in all written communication

Technical Knowledge and Skills Required to Perform the Job:

• Experience in billing, CPT codes, and ICD-10, as well as Medical terminology

Equipment Used:

• General office equipment to include PC and Software (Excel, Word, Office), phone, fax, etc.

Working Conditions and Physical Requirements:

• Sedentary work requires sitting and use of the PC most of the day

Universal Requirements:

Pre-employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment PPDs. Compliance with all mandated vaccinations and all boosters is a term and condition of employment.