Billing Clerk

  • location: Irvine, CA
  • type: Temp to Perm
  • salary: $24 per hour
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job description

Billing Clerk

- The Medicare Biller and Follow Up Representative is responsible for the management of patient accounts from the point of admission to reimbursement from the payor.
- Works directly with patients, internal departments, external business partners (IPA's, provider relations, government payors and insurance companies) and clinical departments for delivery of service to include but not limited to:
- Obtains the maximum reimbursement for hospital services, effectively maintains a professional and ethical relationship with all clients, payors and staff.
- Has expert knowledge of payor contracts, CPT/HCPCS and ICD-10 codes, medical policies, LCD's and medical terminology.
- Works efficiently to ensure accounts are worked thoroughly and within a timely manner.
- Thrives within a team atmosphere, has strong customer service expertise, has a strong ability to multitask and has proficient computer skills.

??? Serve as the account representative for Hoag in working with insurance companies and/or government payors for resolution of payments.
??? Completes daily assigned accounts on the collection work-list.
??? Obtains the maximum amount of reimbursement by evaluating claims at the contract rate with the use of the contract management tool for proper pricing (Examples: APC, DRG, APRDRG).
??? Reviews and initiates the initial appeal for underpayments observing all timely requirements to secure reimbursement due to Hoag.
??? Conducts an audit of accounts for billing and regulatory requirements.
??? Help identifies charge capture and missing charge.
??? Recommends denial edits to help mitigate denials issues.
??? Reviews and completes payor correspondence in a timely manner.
??? Escalates to the payor accounts that need to be appealed due to improper billing, coding and/or underpayments. ??? Reports new/unknown billing edits to direct supervisor for review and resolution.
??? Has a strong understanding of the Revenue Cycle processes, from Patient Access (authorizations & admissions) through Patient Financial Services (billing & collections), including procedures and policies.
??? Has thorough knowledge of managed care contracts, current payor rates, understanding of terms and conditions, as well as Federal and State requirements.
??? Interprets Explanation of Benefits (EOBs) and Electronic Admittance Advices (ERAs) to insure proper payment as well as assist and educate patients and colleagues with understanding of benefit plans.
??? Understanding of hospital billing form requirements (UB04) and familiar with the HCFA 1500 forms.
??? Knowledge of HMO, POS, PPO, EPO, IPA, Medicare Advantage, Covered California (Exchange), capitation, commercial and government payors (i.e. Medicare, Medi-cal)and how these payors process claims.
??? Demonstrates knowledge of and effectively uses patient accounting systems.
??? Performs other duties as assigned.

Working hours: 8:00 AM - 5:00 PM

--Analytical, critical thinking and sound decision making skills.
--Basic skills in Microsoft Office (Word/Excel). Ability to communicate in a clear and professional manner.
--Strong interpersonal skills.
--Ability to problem solve, prioritize and follow-through completely with assigned tasks.

If interested please send resume to

Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad. EEO Employer: Race, Religion, Color, National Origin, Citizenship, Sex, Sexual Orientation, Gender Identity, Age, Disability, Ancestry, Veteran Status, Genetic Information, Service in the Uniformed Services or any other classification protected by law. San Francisco Fair Chance Ordinance: Qualified applicants in San Francisco with criminal histories will be considered for employment in accordance with the San Francisco Fair Chance Ordinance.

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