Managed Care/Commercial Account Specialist
Company: College Medical Center
Location: Long Beach
Posted on: November 26, 2022
The Managed Care/Commercial Billing Specialist is responsible
for the accurate and timely billing of claims to third party
payor/non-government primary and /or secondary/tertiary payor and
intermediaries. The biller monitors and/or corrects submitted
claims to ensure accurate and prompt reimbursement of claims. This
position performs a variety of duties and responsibilities of
resolution on pending billing, rejections, denials, addressing
billing issues/questions, reviewing patient accounts, and follow up
timely. The Managed Care/Commercial Billing Specialist is expected
to maintain the backlog to current, meet the 95% electronic
billing, manage the billing edits, meet the required 95% of
electronic billing, be familiar with clearinghouse edits, Medicare
Prt B Billing, rebills requirements, update and maintain the
billing DOFR matrix, aware of the current regulatory requirements,
electronic and hard copy billing, and UB04 billing formats.
- 2 years of recent Medicare Billing experience - Acute Care
- Knowledge of medical terminology
- Understand UB04 claim form, CPT, HCPCS, ICD-9, and ICD-10
- Proficient with Microsoft Word and Excel computer
- High school diploma.
- Ability to deal effectively with patients, co-workers and other
Ability to work independently
Sitting and Keying for long periods of time. Visual use of computer
80% of the day. Hearing acuity for telephone usage. Light lifting
Normal Office Conditions
*MAJOR TASKS, DUTIES AND RESPONSIBILITIES*
(ALL duties listed below are essential to the job.)
- Employee's conduct conforms to the Mission, Vision, Values, and
Code of Conduct of College Medical Center.
- Values individual differences and demonstrates sensitivity to the
cultural needs of others.
- Respects the rights, privacy and property of others, and
maintains strict confidentiality.
- Effectively protects all health information from unauthorized
access per HIPAA regulations and all applicable local and state
- Exhibits good attendance and punctuality.
Provides appropriate notice prior to vacation/time off and notifies
supervisor a minimum of two hours prior to shift when unable to
come to work
- Observes allotted break and meal periods as prescribed by
Hospital Policy and follows time card procedures by accurately
writing in and out.
- Attends to personal affairs to avoid any interference with
- Adheres to the Dress Code*.*
- Demonstrates an understanding of their personal role in the case
of fire/disaster and participates in Performance Improvement
- Functions with an awareness of patient safety issues and applies
basic principles of safety as identified within the facility.
Follows the occurrence reporting policy and procedure in reporting
any potential safety issues.
* Responsible for billing all third party payor/non-government
primary and /or secondary/tertiary payor and intermediaries.
* Completes daily assigned accounts on the worklist.
* Performs timely billing, follow up review and ensures appropriate
action is taken.
* Ability to maintain an average of 100 claims worked daily.
* Must have knowledge and understanding of contracts pertaining to
billing requirements, current payor rates, understating of terms
and conditions, as well as Federal and State requirements.
* Reviews, corrects, and edits UB04 claim forms for electronic/hard
copy claim submission in accordance with department billing
policies, payor guidelines, and insurance contract
* Communicates errors and/or missing information regarding
patient's insurance, charges, coding, etc. to the corresponding
departments via the Claims with Missing Information/DNFB report
regularly to management.
* Has a strong understanding of the Rev Cycle Processes, from
Patient Access (Auth & Admissions) through Patient Financial
Services (Billing, collections), including procedures and
* Ability to communicate and provide timely feedback.
* Ability to identify charge capture and missing charge.
* Recommends denial edits to help mitigate denial issues
* Reports New and Unknown billing edits to management for review
* Ability to trend issues and provide recommendation for
* Takes ownership and the ability to follow through timely.
* Reviews rejections, billing communication logs, identifies
necessary corrections, and resubmits claims returned on electronic
rejection reports daily.
* Reviews and runs billing reports; Secondary Billing, DSG Deleted
Claims, Mismatch Authorization, and other assigned reports.
* Package claims by payor (Manual Billing).
* Ability to produce reports and aging from billing system to
provide feedback to management.
* Reviews, adds and resolve billing Edits timely, no more than 72
* Meet KPI of 95 % Electronic Billing
* Understands DOFR and Contracts
* Ability to perform complex mathematical calculations
* Ability to net down accounts according to contract and/or policy
* Able to maintain Billing Matrix.
* Document clearly and timely in patient account.
* Responds to email within 24 hours.
* Able to be independent and a problem solver.
* Follows College Medical Center procedures for account management
* Attends department specific training, in-services, staff
meetings, etc. as requested.
* Meet cash goal requirements and KPI's expectations
Performs other duties as assigned.
*JOB SPECIFIC ACCOUNTABILITIES*
Exhibits behavior that is courteous, compassionate, polite,
friendly, and respectful towards patients, visitors, physicians,
and co-workers and extends self to make patients, visitors,
clinical staff, and peers feel welcome and respected.
Job Type: Full-time
* Dental insurance
* Health insurance
* Paid time off
* Vision insurance
* 8 hour shift
* High school or equivalent (Required)
* Medical billing: 2 years (Required)
* UB04 claim form, CPT, HCPCS, ICD-9, and ICD-10 Codes: 1 year
* Medical terminology: 1 year (Required)
* Medical collection: 1 year (Required)
Work Location: One location%58047475%
Keywords: College Medical Center, Long Beach , Managed Care/Commercial Account Specialist, Other , Long Beach, California
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