Medical (Hospital) Billing / Collections Analyst
4 weeks ago
**Overview**:
Our client, a Medical Center facility under the aegis of a California Public Ivy university and one of largest health delivery systems in California, seeks an accomplished **Hospital Billing / Collections Analyst**.
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** Location: 10920 Wilshire Blvd, Ste 1600, Los Angeles, CA 90024**
** Duration: 3 months contract w/ possibility of extension**
**Notes**:
- Onsite role.
- 7:30am - 4:00pm Pacific Time (includes a 30 min break).
**Description**:
- Responsible for accurately processing inpatient and outpatient claims to third party payers, following all mandated billing guidelines. Responsible for ensuring Timely Filing guidelines are met.
- Analyzes and determines which billing procedure should be followed, based upon the type of financial class, e.g., contracts, private insurance carrier, HMOs, Capitated, government programs, Federal/State/Local, Self-Pay accounts in conjunction with type of billing: transplants, grants, admit and cancels, split accounts, interim billing, exhausted days billing, outliers billing, IME billing, MSP billing, Medicare Section 1011 or any combination for facilities: WW, SMH, NPH.
- Analyzes the information submitted by the various departments for billing and the appropriate documentation required for processing a claim form whether submitted hard copy or electronically.
- Analyzes the pre-printed information on the claim form(s) or billing system to ensure that it is accurate and consistent with other information contained in the ADT or patient accounting system and makes corrections, as necessary.
- Edits charges on the claim form(s) or billing system for which departmental and payer guidelines stipulate should not be billed to the sponsor. Recomputes the total amount due prior to submitting the claim e.g., edits unbillable charges on Medicare claims or deletes room and board charges on outpatient claims.
- Reviews the claim forms to identify sensitive diagnosis information and follows guidelines and procedures established by the department to maintain patient confidentiality. i.e., NPH accounts and HIV diagnosis.
- Inputs all the required information needed to complete the claim, edit accordingly and submit either hardcopy or electronically, with all the required documentation i.e., authorizations, reimbursement based on one-time agreements, medical records, pharmacy profiles, acuity letters, daily minor supply letter, sterilization consent forms, treatment authorization requests, Sheriff In-Custody authorizations, hysterectomy consent forms, transplant organ & transport invoices and TARS, Inpatient/Outpatient TARs and SARs, and ABN’s, 1011 required forms, and CMS certs and recerts.
- Obtains and reviews the medical record or on-line reports for additional documentation to be attached to hardcopy claim forms.
- Transmits claims via electronic vendor once all corrections and adjustments have been processed.
- Submits completed claim forms to appropriate carriers with all required supplemental documentation.
- Actively responsible for maintaining the Claim Master in Emdeon, as accurate and clean as possible. For example: by deleting duplicate claims.
- Submits hard copy high dollar claims via certified mail. Works and resolves reject for all assigned claims on a daily basis.
- Assigns accounts to Revenue Integrity Department as needed per set protocol. Bills for late charges as needed. Identifies capitated services. Assures capitated services are billed to the responsible party i.e. medical group, assigned hospital, or health plan.
- Opens and closes IARs as needed. Communicates to reporting Manager identified billing issues and trends timely. Communicates to reporting Manager issues with claim scrubber edits timely.
- Communicates to reporting Manager issues that impact bill holds with outside vendors: i.e., Medical Coding (M Status hold), Extended Business Office vendors i.e. Canfield, USCB.
- Submits necessary adjustments using the correct debit or credit transaction in order to correct account balance and/or claim totals prior to submission. Submits adjustments with appropriate CDM codes.
- When circumstances warrant, transfers all or parts of a patient account charges to the correct account, such as split accounts, admit & cancel Medicare and/or Insurance outpatient or ER overlaps. Submits charge transfers and/or combines charges correctly via patient accounting system.
- Updates case / payer data and documents the reason for the updates; requests rebill, as necessary. Submits adjustment requests exceeding $10,000 to immediate Supervisor or review and approval.
- Maintains an average of 95% on Biller Quality Assurance Reviews. Applies knowledge of HBOC, ICAP, PCIMS, CMS, Medi.Com, Pathways, DDE, EDS systems
- Applies knowledge of Admissions PVU and Case Management ECIN data systems. Demonstrates knowledge in payer various payer websites.
- Documents claim bill date, billed amounts, billing address, billing attachments, claim number, expected
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