Tri-City Medical Center · 10 hours ago
PAR-BILLING REPRESENTATIVE
Oceanside, CA
Full-time
Onsite
Mid Level
3+ years expTri-City Medical Center is a full-service acute care public hospital in San Diego County, specializing in various health services. They are seeking a PAR-Billing Representative responsible for billing facility claims, ensuring accuracy and timely submission to various payers.
Emergency MedicineHealth CareHospitalRobotics
Responsibilities
Maintains a safe, clean working environment, including unit based safety and infection control requirements
Reviews claims daily in multiple billing systems to ensure claim accuracy prior to claim submission
Performs BTR reconciliation when necessary to ensure all claims have dropped in the appropriate system
Splits charges between multiple lines when a zero charge is present on the claim
Reviews the Payer matrix to ensure claims are routed to the appropriate payer
Ensure records are attached to the appropriate claims as required by the payer and sent certified mail
Prior to paper claim submission ensure appropriate address
Obtain the appropriate CMG code prior to submission of Rehab claims
Ensure the correct value code is present prior to secondary claim submission
Review claims for invalid/missing modifiers, invalid number of units (MUE edits), invalid CPT code and date span errors as well as additional edits as required
Coordinates retrieval of pharmacy invoices for 340B billing prior to claim submission
Works electronic insurance rejects daily in order to retransmit with corrected insurance information / data
Identify and notify responsible departments of issues pertaining to incorrect CPT or ICD-10 coding and obtain correct codes from the appropriate department
Transmits bills electronically to all payers, reviews all paper claims prior to submission to ensure electronic transmission is not an option
Works in collaboration with the collectors by reviewing accounts submitted 30+ days ago that have yet to have a payment posted and/or acknowledgement received. Also, will assist in documenting correspondence and/or pulling required documents as outlined within the correspondence
Works in collaboration with the Credit Analyst by assisting in the review of credit balances
May assist in patient calls as well as place follow-up calls to insurance carriers
Training of new hires as necessary to ensure an understanding of the billing system/overall processes
Ensures that patient confidentiality is always protected, both audible and visible
Ensures compliance with all medical practice regulations, such as, but not limited to HIPAA and OSHA
Qualification
Required
3+ years of Acute Care Hospital billing experience, must include Medi-cal, Medicare and Commercial payers
Ability to perform mathematical calculations, balance and reconcile figures
Must be able to read and write in English
Must have ability to demonstrate flexibility and prioritize work load
Knowledge of healthcare payor systems and benefits (Medi-cal, Medicare, HMO, PPO, Work Comp billing guidelines)
Understanding of CPT, ICD10 and HCPCS codes
Demonstrated knowledge of HIPAA rules and regulations
Excellent oral and written communication skills; must be able to function in a team environment
Must possess knowledge of condition codes, value codes and modifiers
Computer skills including Microsoft Office; especially Word, Excel and Outlook
High School Diploma or GED, required
Company
Tri-City Medical Center
Tri-City Medical Center is an acute-care hospital that provides robotic surgery, heart care, emergency services, and many more.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
$33MKey Investors
Department of Health Care Access and Information
2023-08-24Debt Financing· $33M
Leadership Team
Ray Rivas
CFO & Executive VP
Aaron J. Byzak, MBA, FACHE
Chief Strategy Officer (CSO)
Recent News
San Diego Union-Tribune
2024-05-24
San Diego Union-Tribune
2024-05-24
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