JOB SUMMARY:

Under the direction of the Supervisor Professional Billing & Coding follows Federal State & local regulatory collection guidelines as well as payor specific billing/collection guidelines. Responsible for the collection of outstanding balances from all Commercial HMO PPO Medi-Cal & Managed Care payors professional claims. Responsible for identifying issues checking status of unpaid claims by telephone websites and/or any means available. Responsible for providing information & documentation to ensure timely & accurate reimbursement. Manages & assembles all data & documents required for accurate follow-up of claims. Ability to perform complicated calculations to adjudicate accounts appropriately. Ability to analyze & adjudicate contractual arrangements as determined by agreements entered into by the Medical Practive Foundation. Reviews remittance codes from EOB-s & R/A-s to ensure payment or to identify denials or non-payment. Responsible for follow up with payor on the routing of claims. Refers all payor issues/problems to leadership in a timely manner with specific examples. Responsible for accurate & timely documentation of all follow up pertaining to the resolution of the account within the IS system patient financial record.

Skills Required:

• Strong verbal and written communicator

• Problem-solver

• Master negotiator

• Emotional Intelligence

• Attention to detail

MINIMUM QUALIFICATIONS:

High School Diploma, GED, or Equivalent

3 years of experience

Previous billing experience

The expected hiring range for this position is $22.00 to $30.26

Rady Children’s Hospital is committed to compensation that is externally competitive and internally equitable. We demonstrate this commitment by conducting regular market reviews to remain competitive with organizations of similar size in the nonprofit, healthcare sector. The range listed above does not represent the full salary range for the position but is the expected hiring range for qualified candidates. Compensation decisions consider a variety of factors including experience, education, licensure, unique skillsets, organizational need, and internal equity. This posting will remain open from the “date posted” until the hiring manager has determined there is a sufficient applicant pool or until the position is filled.