Key Facts

Remote From:

Canada, California (USA), United States

Freelance

English

Hard Skills

Appeals Accounts Receivable Cash Register Performance Management Account Analysis Good Documentation Practices

Other Skills

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Communication
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Time Management
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Teamwork
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Customer Service
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Mentorship
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Problem Solving

Roles & Responsibilities

Extensive experience with third-party billing and collections for non-governmental payers including commercial insurance, HMO, PPO, EPO, international payers, auto liability and other liability carriers
Proficiency with billing editor software for timely submission of primary and secondary claims, including complex claims (split bills, interim bills, benefits exhaustion)
Leadership and training abilities; acts as Lead, assists newly hired team members, and provides education; able to manage special AR projects with minimal supervision
Strong account reconciliation and analytical skills, including calculating and posting adjustments/write-offs, identifying payer trends, and preparing payer packets

Requirements:

Ensure timely submission of non-governmental claims in the billing editor; prepare and submit primary and secondary claims electronically or in hardcopy per management directives; handle complex claims (split bills, interim bills, benefits exhaustion)
Monitor billing editor for correct edits; report findings to management for approval; submit bridge routines to billing vendor as approved by CBO management
Reconcile complex accounts (split payments, interim claims, benefits exhaustion, sequestration calculations); prepare and submit appeals; perform account analysis and post adjustments/write-offs with management approval
Provide training and education to CBO team members; act as Lead in the department; assist management with special AR projects and prepare payer packets; identify payer trends and communicate insights to management

KPC Health

About KPC Health

The KPC Health is a global leader in healthcare, pharmaceuticals, education, engineering and real estate. Originally founded by world-renowned orthopedic surgeon and entrepreneur, Dr. Kali Chaudhuri, the KPC Group has reached an unprecedented level of success through its vision, innovation, and leadership. Today, the KPC Group has amassed over $10 billion in assets, including hospitals, clinics, schools, commercial real estate properties, and agricultural research centers.As pioneers in technology for the healthcare industry the KPC Group healthcare division, KPC Health, has successfully established a group of integrated healthcare delivery systems consisting of acute care hospitals, Independent Physicians Associations (IPAs), medical groups, urgent care facilities, and various fully integrated multi-specialty medical facilities throughout the western United States.Our California facilities include:Anaheim Global Medical CenterChapman Global Medical CenterHemet Valley Medical CenterMenifee Valley Medical CenterOrange County Global Medical CenterSouth Coast Global Medical CenterVictor Valley Global Medical CenterOur facilities collectively serve some of California’s most densely populated areas in the Southern California region – totaling nearly ten million people.KPC Health has invested nearly $100 million in the latest information technology transforming one of the oldest hospital systems in the United States into a state of the art healthcare operation with an advanced Electronic Medical Records system.Most importantly, we have invested in our people. KPC Health attributes its overall successes to the highly skilled, advanced trained, expert physicians, nurses, information technology specialists and staff. Investing in having the very best workforce has enabled KPC Health to maximize its technological capabilities to best serves its patients, their families and the communities its hospitals and medical institutions it serves.As community hospitals dedicated to the health and welfare of each and every community we serve, we are investing in a number of non-profit and charity-based organizations, including the American Heart Association, March of Dimes for healthy babies, and Caterina’s Club for feeding hungry children. We believe our involvement in the promotion of these programs is crucial to serving our communities.For us, healthcare is not just about caring for our patients, but also about investing in the people of Orange County. Our mission is to ensure everyone we encounter enjoys life in great health.

Founded: 2018

Company size: 1001 - 5000

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Job description

* THIS IS A FULLY REMMOTE POSITION*

SUMMARY

Performs third party billing and collection of accounts for non-governmental third-party payers including traditional commercial insurance carriers, Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), EPO's, International Payers, Auto Liability and other Liability carriers, and all other non-governmental third-party payers. Duties include billing, collections, refunds, adjustments, EOB review, appeals, and denials. Acts as a lead in the department by assisting newly hired team members with answers to questions and stands in for supervisor in supervisor’s absence. Works on special complex high priority projects as assigned by management.

REQUIREMENTS

RESPONSIBILITIES AND DUTIES:

Responsible for ensuring timely submission of non-governmental claims in the billing editor. On a daily basis prepares and submits primary and secondary claims using the billing editor software to submit claims electronically or hardcopy, ensuring all edits are worked in a compliant manner based on directives given by management. Able to prepare and submit complex claims including split bills, interim bills, benefits exhaustion, etc.
Monitors billing editor for correct claim edits and reports findings to management for approval to make edit corrections. Submits bridge routines to billing vendor as necessary and approved by CBO management.
Shows proficiency in the ability to reconcile complex accounts, i.e. split payments, interim claims, benefits exhaustion, sequestration calculation, etc. Prepares and submit appeals as appropriate.
Performs account analysis, calculates and posts adjustments and write-off transactions to patient accounts receivable as appropriate with management approval.
Ensures all charge and coding related issues are clearly identified and entered in the HIM/Charge audit spreadsheet for clarification and resolution. Follows up to ensure timely response from others and ultimate resolutions.
Assists management with completing special AR projects as needed. Demonstrates the ability to complete the project with minimal management intervention. Partners with CBO management to prepare payer packets/spreadsheets of outstanding claims for meetings between CBO and payer representatives.
Provides training and education to CBO team members as requested by management. Acts as a Lead in the department by assisting newly hired team members with answers to questions and also assisting management as requested.
Identifies payer trends and reports to management providing input on appropriate steps to take. Provides account-level support as needed to AR vendors.
Maintains productivity levels within guidelines established by management. Receives an at or above team average productivity score
Documentation. Documents clearly and succinctly in account notes all action taken on account, i.e., phone call numbers, representatives spoken to, corrective action taken, referrals made and specific claim submission details as appropriate.
Performs duties with little or no errors. Remains at or above team average quality of work errors.
Other duties as assigned.