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Rady Children's Hospital-San Diego · 2 hours ago

Billing & Collections Representative I - PFS - RCSSD

San Diego, CA

Full-time

Onsite

Entry Level

$21/hr - $28.88/hr

1+ years exp

Rady Children's Hospital-San Diego is a nonprofit healthcare organization, and they are seeking a Billing & Collections Representative I to manage the processing of charges and claims. The role involves verifying patient information, ensuring accurate billing, and resolving claim issues to facilitate clean claim submission.

Health Care

Responsibilities

Review and process charges via our EMR system

Process the paper charge tickets that are received for services provided at non-RCHSD locations

Ensure that all expected charges are received and entered from providers

Verify authorization when necessary for patient visits and procedures, ensuring it is correctly reflected on submission of the claim

Register new patients in the system, including patient demographics, verifying insurance, eligibility and claim information is accurate

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

Make updates and or corrections as needed for accurate reporting of the service

Complete daily processing of claim edits or rejected claims processed through the billing system and from electronic claim vendor processing

Correct all errors or warning flags to ensure clean claim submission

Pull medical records to submit with claims and appeals as required by payors

Validate and accurately complete the claims identified with potential new payor plan coverage added to the patient's account

Assist with other related duties as assigned