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Patient Financial Services Representative I

2 months ago

San Diego, California, United States Rady Children's Hospital-San Diego Full time

JOB SUMMARY:

Under the supervision of the Manager of Professional Billing & Coding, the Billing & Collections Specialist I is tasked with reviewing and processing charges through our Electronic Medical Record (EMR) system. This role involves handling paper charge tickets received for services rendered at various locations. Utilizing relevant reports, the incumbent ensures that all anticipated charges are accurately received and entered from healthcare providers.

This position is responsible for verifying authorizations when necessary for patient visits and procedures, ensuring that these are correctly reflected in the claim submissions. The incumbent will also register new patients in the system, confirming patient demographics, and verifying insurance eligibility and claim information for accuracy.

Additionally, the role requires verification of the appropriate application of Current Procedural Terminology (CPT) and International Classification of Diseases, 10th Revision (ICD-10) codes and modifiers for all charge sessions and encounters, utilizing specific warnings and edits to flag charges routed to the billing system. The incumbent is expected to make necessary updates or corrections to ensure accurate reporting of services rendered.

The Billing & Collections Specialist I will complete daily processing of claim edits or rejected claims through the billing system and from electronic claim vendor processing. They are responsible for correcting all errors or warning flags to ensure clean claim submissions. This position also entails pulling medical records to submit with claims and appeals as required by payors and validating claims identified with potential new payor plan coverage added to the patient's account.

SKILLS REQUIRED:

  • Exceptional verbal communication and active listening skills.
  • Strong emotional intelligence.
  • Proficient problem-solving abilities.
  • Meticulous attention to detail.
  • Technologically adept.

MINIMUM QUALIFICATIONS:

  • High School Diploma, GED, or equivalent.
  • 1 year of relevant experience.
  • Experience in medical billing.
  • A certificate of completion from a medical billing course may substitute for 1 year of experience.

PREFERRED QUALIFICATIONS:

  • 3 years of relevant experience.
  • Experience with EPIC is a plus.

COMPENSATION:

The expected hiring range for this position is $21.00 to $27.50. Rady Children's Hospital is dedicated to maintaining compensation that is both externally competitive and internally equitable. We achieve this by conducting regular market reviews to remain competitive with organizations of similar size in the nonprofit healthcare sector. The range listed above represents the expected hiring range for qualified candidates, with compensation decisions considering various factors including experience, education, licensure, unique skill sets, organizational needs, and internal equity.

BENEFITS:

  • Medical, dental, and vision insurance.
  • Life insurance and pet insurance options.
  • A retirement plan with company matching.
  • A wellness program.
  • Tuition assistance.
  • Employee recognition awards and events.
  • Discounts on events and attractions.
  • Various opportunities for community engagement and enjoyment.