Hospital Billing and Follow Up Specialist (Open & Promotional)

County of San Mateo • San Mateo, CA

7d • Onsite

About The Position

San Mateo Medical Center (SMMC), an acute care facility in San Mateo, California, seeks an experienced Hospital Billing and Follow Up Specialist to perform complex billing functions and business services support work. The role researches and follows up on denied claims for services provided at SMMC hospitals and clinics, while complying with HIPAA and payer regulations. It manages account caseloads, resolves billing questions with fiscal intermediaries, physicians, and others, uses a hospital billing system to enter, retrieve, and interpret data, and prepares reports and maintains accurate records. Lead direction is not a regular duty, though project or relief leadership may be required.

This is a regular, full-time position. The recruitment may also generate an eligible list for future extra-help, term, unclassified, and regular classified vacancies. The typical qualifying background is one year of journey-level office support experience in a patient services setting, or an equivalent combination of education and experience. Selection includes application screening and a panel interview; further evaluation or an application appraisal may be used depending on applicant volume.

Requirements

• Experience in hospital billing and Medicare account follow-up using EPIC.
• Proven experience with medical claims billing and follow-up, including two years of hospital and/or clinical billing and collections.
• Experience with Medicare and FQHC reimbursement.
• EPIC EHR/Resolute experience and proficiency in the EPIC system.
• Knowledge of Medicare Part A and Part B billing requirements.
• Knowledge of hospital inpatient and outpatient billing, including UB-04/837I institutional claims.
• Knowledge of professional and clinic billing, including CMS-1500/837P professional claims.
• Knowledge of Medicare coverage guidelines, medical necessity, and documentation requirements.
• Knowledge of Medicare remittance advice, including CARCs and RARCs, and adjustment reason codes.
• Understanding of contractual adjustments, deductibles, coinsurance, and underpayments.
• Knowledge of medical terminology related to patient services support work.
• Knowledge of policies and procedures related to patient services, office support, and hospital or clinic business office activities.
• Knowledge of office administrative practices, filing, and standard office equipment.
• Knowledge of basic business data processing principles and word processing or computing equipment.
• Knowledge of proper form for typed materials, business arithmetic, correct English usage, and record-keeping principles and procedures.
• Ability to perform technical, specialized, complex, or difficult patient services office support work.
• Ability to organize, prioritize, and coordinate work activities; interpret and apply rules, policies, and procedures; and organize, research, and maintain patient and general office files.
• Ability to establish effective working relationships, compose routine correspondence, make accurate arithmetic calculations, and use sound independent judgment within established guidelines.
• Ability to operate standard office equipment, including a word processor, personal or online computer, and centralized telephone equipment, as well as fax machines and scanners.
• Some specific positions may require typing 40 net words per minute from printed copy.
• Typical qualifying experience: one year of journey-level office support experience in a patient services setting, or an equivalent combination of education and experience.

Responsibilities

• Research and compliantly follow up on denied claims for hospital and clinic services.
• Research payer guidelines and regulations.
• Manage and monitor a caseload of accounts.
• Resolve billing questions with fiscal intermediaries, physicians, and others.
• Enter, retrieve, and interpret data using a hospital billing system.
• Prepare reports and maintain accurate records.
• Resolve hospital and physician claims while adhering to HIPAA and payer regulations.
• Provide project or relief leadership when required.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed