Government Specialist II (Hybrid Work Model)

KPC GLOBAL MEDICAL CENTERS•Santa Ana, CA

6d•Hybrid

About The Position

For governmental third-party payers including Medicare, Medicaid, Medi-Cal, Veterans' Campus, Tri-Care, County, and other governmental payers, this role performs third-party bill preparation, editing, and submission (both paper and electronic). The specialist ensures accurate identification of expected reimbursement amounts, calculates and posts adjustments and write-off transactions to patient accounts receivable, handles collections, follows up on unpaid accounts, analyzes patient accounts, prepares appeals, identifies over-payments, and initiates and processes refund requests to third-party payers. The role also escalates recurring issues that prevent effective and efficient processes needed for goal attainment.

Requirements

Some college preferred.
2 years' experience in a medical office or hospital setting.
Knowledge of CPT, HCPC’s, HIPAA, Compliance and Regulatory issues.
Knowledge of billing systems and software applications.
Ability to lift and move up to 25 pounds.

Responsibilities

Ensuring timely submission of governmental claims in the billing editor.
Preparing and submitting primary and secondary claims using billing editor software, electronically or hardcopy, ensuring all edits are worked in a compliant manner.
Collecting unpaid or partially paid accounts by utilizing ATB reports, reviewing EOBs and correspondence, and taking appropriate action to resolve issues and secure correct payment, including timely filing of appeals.
Identifying accurate and efficient reimbursement amounts and posting appropriate adjustments.
Identifying over-payments.
Initiating and processing refund requests to third-party payers in compliance with governmental regulations.
Ensuring all charge and coding related issues are clearly identified and resolved or entered on the appropriate HIM/Charge audit spreadsheet for correction/resolution.
Assisting with and completing time-sensitive projects related to outstanding accounts receivables within stated timeframes.
Maintaining productivity levels within established guidelines and achieving at or above team average productivity scores.
Clearly and succinctly documenting all actions taken on an account in account notes, including phone numbers, representative names, call reference numbers, corrective actions, referrals, and specific claim submission details.
Performing duties with little or no errors, maintaining at or above team average quality of work.
Performing other duties as assigned.