General Information
| Payroll Title | UNCLASSIFIED | Title Code | 009995 | Grade/Step | 15 | Working Title | Patient Biller |
|---|---|---|---|---|---|---|---|
| Department Name | Clinical Affairs Dept | Supervisor | Kerl, Maryam P | Department Head | Borda, Louise Anne |
Special Requirements and Conditions
| Critical Position |
| Overtime |
Level of Supervision Received
| General Direction |
Items Used
| Standard Office Equipment (e.g. Computer, Fax, Copier etc...) |
Position Purpose
| Responsible for initial billing procedures for patient care and for subsequent actions required to assure correct, expeditious payment of patient bills and perform other related duties as assigned. Incumbents apply a complete knowledge of private insurance, government programs, and uninsured patient billing procedures, as well as a knowledge of university procedures, such procedures being complex and subject to frequent revision. Billers maintain and use rate manuals and computer-generated data in initiating correct billing procedures; follow-up by telephone, personal inquiry, or statement to the proper source; review all accounts monthly; interpret carrier payments; verify accuracy of payments using knowledge of disallowances and percentage payments; and make corrections as necessary. Under supervision, incumbents typically audit patient accounts, prepare and complete third-party claims for electronic/hard copy submission; identify and post payments to individual accounts; perform patient billing; balance case accounts; identify, prepare and apply contractual allowances; initiate telephone inquiries to identify payments and remittances; photocopy various billing documents; update online patient account system; review patient correspondence to determine if self-pay accounts may be billable; and establish liability accounts. Supports all the basic operational aspects of the physician practices as related to patient registration, eligibility and benefit verification and securing authorizations. Additionally, this position will facilitate, coordinate and manage the transmission of all billing encounters. |
Essential Functions
| Essential Function | % Time |
|---|---|
| Patient Billing | 80 |
| Perform patient registration, establishing medical record in EMR, verifying benefits and eligibility, securing authorizations from health plans/payors of clinical services for our patients in the hospital at UCR Health clinical affiliate sites. Collect and review all billing encounters for completeness. Manage communication to billing vendor and ensure reconciliation process is managed to account for all charges. Manage communication of all necessary billing data to coding staff and coding vendor and subsequently to billing vendor. Provide additional information as needed to support coding efforts. Identify, assess, and correct any credentialing concerns, registration and billing information that may prevent the transmission of the patient bill to the payor. Reconciles, researches and resolves discrepancies in patient financial data. Identify trends related to unbillable encounters and develop process for addressing missing data. Other duties as assigned. |
|
| Patient Billing Support | 20 |
| Retrieve all necessary operative reports from various inpatient and outpatient locations and EMRs. Review all charges and medical record prior to the information to prepare the patient bill goes to the payor. Access various payor sites to review payments and status of claims. |
|
Minimum Requirements
| Minimum Requirement | Display Ranking |
|---|---|
| 1 | |
| Associates degree in a related field and at least one (1) year of related experience performing healthcare billing and insurance verification work. In lieu of the Associate degree requirement, candidates can substitute an additional two (2) years of directly related experience, for a total of three (3) years of experience. | |
| 2 | |
| Understanding of third party payor networks and managed care processes for the local market. | |
| 3 | |
| Knowledge of policies and procedures for clinical operations and basic billing practices. Understanding of third party payor networks and managed care processes for the local market. Basic knowledge of CPT coding and clinical documentation requirements. | |
| 4 | |
| Proficiency in Microsoft Office applications, Word, Excel, PowerPoint, Access, and internet resources. | |
| 5 | |
| Familiarity/experience with practice management/billing information systems and electronic medical records. | |
| 6 | |
| Basic knowledge and understanding of internal control practices and their impact on protecting university resources. | |
| 7 | |
| Interpersonal skills; service orientation; active listening; critical thinking; attention to detail, ability to multi-task in a high volume environment, effective verbal and written communication skills, organizational skills. |
|
| 8 | |
| Ability to function effectively as a member of a team. | |
| 9 | |
| Ability to research and analyze data. Ability to work independently with minimal supervision. Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization. Ability to organize and prioritize work and manage multiple priorities in a high volume, demanding environment. | |
Preferred Qualifications
| Preferred Qualification | Display Ranking |
|---|---|
| 1 | |
| EPIC experience. | |
| Posted Position Purpose |
|---|
| Responsible for initial billing procedures for patient care and for subsequent actions required to assure correct, expeditious payment of patient bills and perform other related duties as assigned.
Incumbents apply a complete knowledge of private insurance, government programs, and uninsured patient billing procedures, as well as a knowledge of university procedures, such procedures being complex and subject to frequent revision. Billers maintain and use rate manuals and computer-generated data in initiating correct billing procedures; follow-up by telephone, personal inquiry, or statement to the proper source; review all accounts monthly; interpret carrier payments; verify accuracy of payments using knowledge of disallowances and percentage payments; and make corrections as necessary.
Under supervision, incumbents typically audit patient accounts, prepare and complete third-party claims for electronic/hard copy submission; identify and post payments to individual accounts; perform patient billing; balance case accounts; identify, prepare and apply contractual allowances; initiate telephone inquiries to identify payments and remittances; photocopy various billing documents; update online patient account system; review patient correspondence to determine if self-pay accounts may be billable; and establish liability accounts.
Supports all the basic operational aspects of the physician practices as related to patient registration, eligibility and benefit verification and securing authorizations. Additionally, this position will facilitate, coordinate and manage the transmission of all billing encounters.
Please Note: The classification title (expected Patient Biller 2) and salary range for this position are currently under review. The candidate will be placed on the anticipated salary range of $20.85 - $26.45 in accordance with the step placement methodology as defined in the collective bargaining agreement. The proposed title code for this position is covered under the AFSCME Patient Care Technical Unit Contract (EX). |
| Posted Minimum Requirements |
| Associates degree in a related field and at least one (1) year of related experience performing healthcare billing and insurance verification work. In lieu of the Associate degree requirement, candidates can substitute an additional two (2) years of directly related experience, for a total of three (3) years of experience. Understanding of third party payor networks and managed care processes for the local market. Knowledge of policies and procedures for clinical operations and basic billing practices. Understanding of third party payor networks and managed care processes for the local market. Basic knowledge of CPT coding and clinical documentation requirements. Proficiency in Microsoft Office applications, Word, Excel, PowerPoint, Access, and internet resources. Familiarity/experience with practice management/billing information systems and electronic medical records. Basic knowledge and understanding of internal control practices and their impact on protecting university resources. Interpersonal skills; service orientation; active listening; critical thinking; attention to detail, ability to multi-task in a high volume environment, effective verbal and written communication skills, organizational skills. Ability to function effectively as a member of a team. Ability to research and analyze data. Ability to work independently with minimal supervision. Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization. Ability to organize and prioritize work and manage multiple priorities in a high volume, demanding environment. |
| Posted Preferred Qualifications |
| EPIC experience. |