Job description

Our client, a Medical Center facility under the aegis of a California Public Ivy university and one of largest health delivery systems in California, seeks an accomplished Medical Biller/Collector.

NOTE- THIS IS AN ONSITE ROLE & ONLY W2 CANDIDATES/NO C2C/1099

*** Candidate must be authorized to work in USA without requiring sponsorship ***

Position: Medical Biller/Collector (Job Id: 81986035)

Location: Los Angeles CA 90404

Duration: 3 Months + Strong Possibility of Extension

JOB DESCRIPTION

HOSPITAL Insurance Collections experience required.

Biller is responsible for accurately processing inpatient and outpatient claims to third party payers, following all mandated billing guidelines. He/she is responsible for ensuring Timely Filing guidelines are met. The Biller must have the ability to perform all required duties within the patient accounting systems. Skilled in the usage of all Microsoft applications and other programs as defined by the Patient Business Services Management Staff.

TECHNICAL BILLER DUTIES

Billing Tasks

· Analyzes and determines which billing procedure should be followed, based upon the type of financial class, e.g., contracts, private insurance carrier, HMOs, Capitated, government programs, Federal/State/Local, Self-Pay accounts in conjunction with type of billing: transplants, grants, admit and cancels, split accounts, interim billing, exhausted days billing, outliers billing, IME billing, MSP billing, Medicare Section 1011 or any combination for facilities: WW, SMH, NPH

· Analyzes the information submitted by the various departments for billing and the appropriate documentation required for processing a claim form whether submitted hard copy or electronically.

· Understands all electronic billing vendors applicable to the enterprise and payer type.

· Contacts by telephone or e-mail the appropriate departments to obtain the required information needed to process a claim.

· Analyzes the pre-printed information on the claim form(s) or billing system to ensure that it is accurate and consistent with other information contained in the ADT or patient accounting system and makes corrections as necessary.

· Edits charges on the claim form(s) or billing system for which departmental and payer guidelines stipulate should not be billed to the sponsor. Recomputes the total amount due prior to submitting the claim e.g. edits unbillable charges on Medicare claims or deletes room and board charges on outpatient claims.

· Reviews the claim forms to identify sensitive diagnosis information and follows guidelines and procedures established by the department to maintain patient confidentiality. i.e. NPH accounts and HIV diagnosis.

· Inputs all the required information needed to complete the claim, edit accordingly and submit either hardcopy or electronically, with all the required documentation. i.e. authorizations, reimbursement based on one-time agreements, medical records, pharmacy profiles, acuity letters, daily minor supply letter, sterilization consent forms, treatment authorization requests, Sheriff In-Custody authorizations, hysterectomy consent forms, transplant organ & transport invoices and TARS, Inpatient/Outpatient TARs and SARs, and ABN’s, 1011 required forms, and CMS certs and recerts.

· Obtains and reviews the medical record or on-line reports for additional documentation to be attached to hardcopy claim forms.

· Transmits claims via electronic vendor, once all corrections and adjustments have been processed.

· Submits completed claim forms to appropriate carriers with all required supplemental documentation

· Actively responsible for maintaining the Claim Master in Emdeon, as accurate and clean as possible. For example: by deleting duplicate claims.

· Submits hard copy high dollar claims via certified mail

· Works and resolves rejects for all assigned claims on a daily basis

· Assigns accounts to Revenue Integrity Department as needed per set protocol.

· Bills for late charges as needed.

· Identifies capitated services.

· Assures capitated services are billed to the responsible party i.e. medical group, assigned hospital, or health plan.

· Opens and closes IARs as needed.

· Communicates to reporting Manager identified billing issues and trends timely.

· Communicates to reporting Manager issues with claim scrubber edits timely.

· Communicates to reporting Manager issues that impact bill holds with outside vendors: i.e. Medical Coding (M Status hold), Extended Business Office vendors i.e. Canfield, USCB.

· Submits necessary adjustments using the correct debit or credit transaction in order to correct account balance and/or claim totals prior to submission.

· Submits adjustments with appropriate CDM codes.

· When circumstances warrant, transfers all or parts of a patient account charges to the correct account, such as split accounts, admit & cancel Medicare and/or Insurance outpatient or ER overlaps. Submits charge transfers and/or combines charges correctly via patient accounting system.

· Updates case / payer data and documents the reason for the updates; requests rebills as necessary.

· Submits adjustment requests exceeding $10,000 to immediate Supervisor or review and approval.

· Applies proficiency in understanding and applying contractual terms of our Managed Care contracts (PPO, HMO, EPO, POS, Medi-Cal, Medicare).

· Maintains an average of 95% on Biller Quality Assurance Reviews

· Applies knowledge of HBOC, ICAP, PCIMS, CMS, Medi.Com, Pathways, DDE, EDS systems

· Applies knowledge of Admissions PVU and Case Management ECIN data systems

· Demonstrates knowledge in payer various payer websites.

· system Folder Notes / Account Documentation

· Documents claim bill date, billed amounts, billing address, billing attachments, claim number, expected payment, contractual amount, received payments, DRG #, DRG amount, actual transplant date(s), type of transplant, pre and post periods for transplant days, and all pertinent billing data relevant to billing the claim.

· Documents in a clear, concise and grammatically correct manner in system folder notes.

Bhupesh Khurana

Company Overview:

Amerit Consulting is an extremely fast-growing staffing and consulting firm. Amerit Consulting was founded in 2002 to provide consulting, temporary staffing, direct hire, and payrolling services to Fortune 500 companies nationally, as well as small to mid-sized organizations on a local & regional level. Currently, Amerit has over 2,000 employees in 47 states. We develop and implement solutions that help our clients operate more efficiently, deliver greater customer satisfaction, and see a positive impact on their bottom line. We create value by bringing together the right people to achieve results. Our clients and employees say they choose to work with Amerit because of how we work with them - with service that exceeds their expectations and a personal commitment to their success. Our deep expertise in human capital management has fueled our expansion into direct hire placements, temporary staffing, contract placements, and additional staffing and consulting services that propel our clients businesses forward.

Amerit Consulting provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Applicants, with criminal histories, are considered in a manner that is consistent with local, state and federal laws.

Job Types: Full-time, Contract

Salary: Up to $33.00 per hour

Benefits:

• Health insurance

Schedule:

• 8 hour shift
• Monday to Friday

Ability to commute/relocate:

• Los Angeles, CA: Reliably commute or planning to relocate before starting work (Required)

Experience:

• HOSPITAL Insurance Collections: 1 year (Required)

Work Location: In person

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