Billing & Collections Representative I - PFS - RCSSD

JOB SUMMARY:

Under the direction of the Manager, Professional Billing & Coding, the Billing & Collections Rep I is responsible to review and process charges via our EMR system. They are responsible to process the paper charge tickets that are received for services provided at non-RCHSD locations. Using applicable reports, the incumbent ensures that all expected charges are received and entered from providers. This position verifies authorization when necessary for patient visits and procedures, ensuring it is correctly reflected on submission of the claim. They register new patients in the system, including patient demographics, verifying insurance, eligibility and claim information is accurate. Incumbent will verify appropriate use of Current Procedural Terminology (CPT) and International Classification of Diseases, 10th Revision (ICD-10) codes and modifiers for all charge sessions/encounters utilizing Rady specific warnings and CCI edits flagging the charges routing to the billing system. They are expected to make updates and or corrections as needed for accurate reporting of the service. The incumbent completes daily processing of claim edits or rejected claims processed through the billing system and from electronic claim vendor processing, They are to correct all errors or warning flags to ensure clean claim submission. This position is responsible for pulling medical records to submit with claims and appeals as required by payors. Responsible to validate and accurately complete the claims identified with potential new payor plan coverage added to the patient's account. Assists with other related duties as assigned.

SKILLS REQUIRED:

• Excellent verbal communication and active listening. Effective verbal communication is one of the most valuable skills in this role!
• Emotional intelligence
• Ability to solve problems
• Attention to detail
• Technically savvy

MINIMUM QUALIFICATIONS:

H.S. Diploma,GED,or Equivalent

1 Year of Experience

Medical billing experience

A certificate of completion from a medical billing course can be substituted for 1 year of experience

PREFERRED QUALIFICATIONS:

3 Years of Experience

EPIC experience a plus

The current salary range for this position is $23.00 to $28.88

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.