Under general supervision, supervises, assigns, and coordinates the daily operations of a clerical unit performing complex third party billing, collections and other activities of the Business Office at San Joaquin General Hospital; performs complex billing functions and quasi-administrative analysis of hospital billing, claim denials, reimbursement, and collections; and does related or other work as required in accordance with Rule 3, Section 3, of the Civil Service Rules.
This is a supervisory class in the Business Office patient billing section. Incumbents in this position are responsible for the daily supervision of one or more sections of clerical staff assigned to patient accounts performing the duties of billing third party claims to various payers and collections of patient accounts; may perform related office activities and may serve as a resource to staff regarding billing and collection rules and regulations.
Supervises, assigns, coordinates, and evaluates the work of clerical staff performing complex billing and/or collection processes; monitors work flow and implements changes to maximize billing productivity; assists with establishing standards for work performance; ensures claims are billed timely and correctly to maximize reimbursements and increase cash flow.
Confers with insurance representatives, internal and external agency staff and others on billing matters and answers questions that involve researching and abstracting technical data and detailed explanation of regulations, policies or procedures; refers matters that may require policy decisions to management.
Confers with other departmental sections to assure timely and accurate flow of information necessary to patient account billing; reviews documents and system data for charge errors; participates on task forces and committees as assigned.
Researches accounts; resolves or handles more difficult and complex billing problems, appeals, and complaints; troubleshoots system issues and recommends improvements.
Trains staff in complex billing and collection procedures, policies and practices; orients new employees to billing and collections; researches and answers questions and applies billing and collection rules, regulations, and guidelines; updates staff to changes in policies, standards and regulations; disseminates information affecting other departments quickly and accurately.
Prepares and audits claims, statements and reports from a variety of sources; performs technical clerical accounting work; monitors accounts and prepares reports.
Experience: Three years experience performing insurance billing, collection, or accounts receivable in a hospital environment within the last five (5) years.
Medical terminology, coding, procedure and diagnosis codes; completion of UB04 and CMS 1500 claims forms, government, managed care and third party payer billing, electronic claim submission systems and hospital patient accounting systems; accounts receivable methods and procedures; claim attachment specifications; regulatory and legal guidelines; appeals processes; principles of planning and organizing work; methods of researching, gathering, organizing and reporting data; personal computer systems and general office computer software; public relations techniques; advanced filing and record keeping systems; complex correspondence and report formats; arithmetical operations related to advanced clerical/technical/financial processes; basic principles of training and supervision; advanced cash handling procedures.
Research, interpret and apply complex laws/regulations relating to submission of hospital claims; evaluate and establish priorities; gather, organize, input and maintain account data; provide/obtain detailed information to/from others, even in difficult situations; develop, create and deliver educational projects to clerical and professional staff; utilize advanced office procedures and equipment; follow complex oral and written procedures and directions; establish and maintain effective working relationships with others; communicate effectively with others; write clearly and legibly; perform advanced arithmetical operations; supervise others.
Mobility-Frequent operation of a data entry device, repetitive motion, sitting for long periods, walking; occasional standing, pushing, pulling, bending, squatting, climbing; Lifting-Frequently 5 pounds or less; occasionally 5 to 30 pounds; Visual-Constant good overall vision and reading/close-up work; frequent color perception and use of eye/hand coordination; occasional use of depth perception and peripheral vision; Hearing/Talking-Frequent hearing of normal speech, hearing/talking on the telephone, talking in person; Emotional/Psychological-Frequent decision making, concentration, and public contact; Special Requirements-Some assignments may require working weekends, nights, and/or occasional overtime; Environmental-Occasional exposure to varied weather conditions.