Job Summary:Under the supervision of a Manager/Supervisor, the Billing Specialist II performs all billing, editing and research functions to process claim submissions. The billing specialist works collaboratively with other departments including but not limited to revenue cycle, claims and member services.The billing specialist is primarily responsible for accurate and timely claim submission to internal and external payors adhering to government regulations and payor specific policies, ensuring proper account documentation is maintained in the system of record to support all billing activities.Essential Responsibilities:
Works daily electronic/manual work list by researching and resolving claim edits, especially but not limited to complex Medicare/Medi-Cal/HHH accounts, performing claim corrections by accessing supplemental system such as Bedrock, foundations, ePremis and others.
Validates insurance information (using system such as Passport, DDE and CWF), review eligibility and ensure correct coverage is attached to the claim.
Research and resolve payor rejects (277 response)/denials and process resubmission.
Performs payor follow up (call customer service) on unpaid claims for status and perform necessary action for resolution.
Identify, analyze and resolve complex errors and billing issues in Medicare DDE portal.
Monitors for trends and issues within scope of work, reports findings to lead biller and/or manager.
Participates and attends meetings, training seminars and in-service to develop job knowledge and keep abreast of payor requirements and regulatory changes.
Assists in reviewing and/or resolving credit balances
Documents required information and account notes in the system of record in a timely and accurate manner.
Confidentiality/Security of Systems: Maintains and complies with policies and procedures for confidentiality of all patient records.
Demonstrates knowledge of privacy and security of systems and associated policies and procedures for maintaining the security of the data contained within the systems.
Other Duties: Performs other duties as assigned within the job function.
Basic Qualifications:
Experience
Three years medical office billing experience for a hospital or clinic environment.
Education
High School Graduate or GED.
License, Certification, Registration
N/A
Additional Requirements:
Achieve a minimum score of 80% on the Billing Specialist II Assessment.
Basic knowledge and use of Microsoft Office applications (Word, Excel, PowerPoint etc.)
Knowledge of billing requirements and reimbursement methodologies.
Must be able to meet productivity and quality standards established for the position
Demonstrated ability to work in an electronic medical records environment.
Basic knowledge of reimbursement methodologies and conventions and knowledge of rules and guidelines for the appropriate and current claim form requirements for both professional and instituitional billing.
Must be willing to work in a Labor Management Partnership environment.
Preferred Qualifications:
N/A
COMPANY: KAISERTITLE: Billing Specialist IILOCATION: Oakland, CaliforniaREQNUMBER: 1250708External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.
