Revenue Cycle Billing Associate II

2 weeks ago


Los Angeles, United States Pediatric Management Group Full time
Job DescriptionJob Description

The Billing Associate II position is responsible for assuring the timely submission/resubmission of a clean and accurate claim (electronic & paper), which includes reviewing all claim information and attaching supporting documentation as required by payer prior to bill submission.

Claim Reviews:

  • Paper Claims
  • Review charge tickets for information and required documents, based on specific divisions and payer requirements, including items such as Insurance verification, Eligibility, Diagnosis code (s), Procedure Code (s) and all other items required by Billing System/Payer.
  • Enter charges per division guidelines, utilizing documentation provided, assuring highest level of accuracy, including items entered via SharePoint workflow.
  • Maintain billing logs of charges to be used for reconciliation between divisions and revenue cycle.

Electronic Claims

  • Work all billing edits including items such as Insurance verification, Eligibility, Diagnosis code (s), Procedure Code (s) and all other items required by Billing System/Payer.
  • Accurately post/void adjustments and patient payments as needed.
  • Responsible for overseeing custom division workflows outside of the standard specialty procedure workflow.
  • Requests documentation from clinics, patients and or insurance companies as appropriate.
  • Resubmit claims with updated or corrected information per payer guidelines.
  • As appropriate, refers claims to Revenue Cycle division responsible for update or correction (s).
  • Correctly documents claim notating actions taken or actions needed to properly submit to payer.
  • Ability to work complex/escalated claims.
  • Responsible for oversite of all Medical Divisions & assigned Surgical Divisions.
  • Escalates problematic claims, with possible recommendations, to the lead or other designated billing personnel.
  • Assists with training and mentoring new hires or peers.
  • Assist with special projects as needed.
  • Maintains understanding of current billing processing guidelines.
  • Consistently meets productivity and quality standards.

Hybrid Position

 

Company DescriptionPediatric Management Group manages 600+ physician academic practice affiliated with Children's Hospital Los Angeles.Company DescriptionPediatric Management Group manages 600+ physician academic practice affiliated with Children's Hospital Los Angeles.

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