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Patient Financial Services Representative II (Biller/Follow-Up)

Oak Valley Hospital District Oakdale, CA
  • Posted: over a month ago
  • Full-Time
  • Benefits: Vision, Medical, Life Insurance, 401k, Dental

Performs a variety of complex clerical tasks utilizing knowledge of computerized claims transmission. Performs follow-up on accounts that may need additional charges or adjustments. Responsible for collections of various types of underpayments created after payment was received and maintains records of these variances and identifies trends.

1. Originates and/or processes records and information related to billing.

2. Obtains information from ancillary sources and incorporates into billing process; interprets insurance requirements and regulations.

3. Processes medical claims to appropriate payer within acceptable time period and following OVHD procedures.

4. Make adjustments for non-covered charges.

5. Completes QA for admitting and correct charges.

6. Performs corrections and adjustments of Medi-Care accounts on DDE as notified by Medi-Care

7. Sends request for and follows with appeals for complete Medi-Cal extensions and TARs.

8. Answers questions and concerns presented by patients, physicians, insurance companies and other hospital staff.

9. Performs research of accounts to ensure payment and/or require additional charges or adjustments.

10. Responsible for collections of various types of underpayments created after payment received. Works with payors, medical groups and other internal hospital departments in order to resolve underpayments, usually based on different interpretations of contract language or approved level of care situations.

11. Ensures compliance with Payment Card Industry (PCI) – Data Security Standards (DSS) and training, with regards to credit card transactions and cardholder information.

12. Performs continuous follow-up to ensure that demands for payment of underpayment are received.

13. Maintains records of underpayments by payors, causes for underpayments, identifying trends of underpayments and underpayment dollars collected by payor.

14. Provides management with reports on results and trends. Works with management to determine resolution to avoid future underpayments.

15. Answers incoming correspondence.

16. Performs Quality Control Procedures.

17. Follows up on patient accounts and alerts PFS Manager to problem areas.

18. Participates in the education, training programs and staff meetings of the department.

19. Performs any clerical duties required.

20. Assists in other areas of the department when needed.

Minimum Education:

Thorough understanding of HCFA 1500 and UB-92 billing required

Basic understanding of CPT and ICD-9 coding preferred

Basic knowledge of governmental and managed care programs billing requirements necessary

Medical terminology

Minimum Experience/Skills:

Three (3) years computerized medical billing or related experience preferred

Previous experience in the analysis of patient accounts to determine when and if an underpayment condition exists.

Meditech and/or computer system processing preferred

Recent experience with hospital contract language

Excellent verbal and written communication skills

PC literate, typing, data entry, 10-key PC skills preferred

Proficient in Excel

Able to perform basic mathematical calculations

Bilingual (English/Spanish) preferred

Physical Demands:

Prolonged sitting

Considerable standing/walking

Lifts, positions, pushes up to 50 pounds

Considerable reaching, stooping, bending, kneeling, crouching

Manual dexterity and mobility

Ability to move quickly

Vision Requirements:

Ability to adjust vision sufficiently to perform duties

Working Conditions:

Subject to irregular hours

Increased stress due to multiple calls and inquiries

Able to work in spite of frequent interruptions

Subject to varying and unpredictable situations

EOE/Vet/Disability

Oak Valley Hospital District

Why Work Here?

Fantastic benefits, 15.9% pension, incredible culture!

A little about us, with over 600 employees and in a growth mode, Oak Valley Hospital District is a full service, non-profit public hospital created to provide residents of Oakdale and the surrounding rural communities, with access to superior quality medical care. We also operate four community health centers providing primary care medical services and plan to expand this business as well. As an organization we take care of nearly 90,000 patients a year.

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