Job Requisition Number: 23330. UC Berkeley School of Optometry operates clinics 7 days per week, year-round, providing vision care at more than 70,000 patient encounters per year in 13 primary and specialty care departments. The majority of patients have some form of government or private vision or medical insurance that they utilize for service.
The Billing Department is responsible for executing and coordinating insurance billing activities including the paneling of faculty providers, reviewing medical charts for billing accuracy and compliance, claims submission, payment reconciliation, payment follow-up and resolving patient insurance issues.
Under the supervision of the Clinic Operations Manager and collaborating with other members of the billing team the Medical Biller assures that billing and payment processing is completed in a timely, accurate and compliant manner. The position also provides customer service to patients with billing concerns, students with insurance questions and professional feedback to clinic faculty, staff and administration on billing related issues.
Prepare and submit insurance claims to medical and vision insurance providers produce patient statements. ?Assist in verifying completeness and accuracy of charge captured information by reviewing daily schedule and charts for appropriateness and completeness of charges, PQRS and Meaningful use data. ?Using the Practice Management System, generate and scrub claims taking corrective action in a timely manner. ?Generate claims batches and transmit to carrier electronically. ?Review claims transaction reports to capture detail related to first-blush denials. Identify and make corrections to denials, alerting Clinic Administration, IT of chronic denials due to coding selections. Correct rejected claims that result from: no ID number, wrong gender, wrong age, etc. and rebill claims. ?Review and resolve any claims that have been on HOLD status to resolve payment or billing issues.
Process EOP?s and monitor claim and patient payments. ?Post payments to visits in the electronic medical records system upon receipt of payment for claims. ?Process claim balances to secondary payors or patient balances as required. ?Correct and resubmit denied claims as required. ?Monitor unpaid claims and follow up with insurance carriers in a timely manner to insure payment. ?Monitor delinquent patient accounts and convert to collections as required. ?Generate regular reports on the status and completeness of insurance and patient responsible balances, payments, adjustments and write offs. Assist in training staff, faculty and students in compliant charting and posting of charges. ?Provide professional feedback to faculty and staff on data entry or compliance issues that hinder the timely completion of the billing process ?Report repeated problems to clinic administration. Maintain fee schedules. ?Work with clinic administration and IT department to insure proper maintenance of fee schedules and insurance allowed amounts in Eyecare PM/EMR to insure proper automated posting of charges to patient ledgers. Assist in credentialing/paneling faculty with insurance carriers. ?Maintain accurate rosters of providers per insurance carriers as assigned. ?Communicate roster status as required to insure patients are scheduled with credentialed providers. Monitor the need to acquire referrals and insurance authorizations. ?Monitor appointments for patients with medical PPO or HMO insurance, acquire authorizations and referrals as required. ?Communicate patient financial responsibilities to appropriate parties.
Other duties as assigned.?High school diploma or equivalent. ?At least 2 years of experience in medical billing process including charge entry, payment posting and claim follow-up. ?Employment experience in health insurance industry such as customer service and claims processing ?Full knowledge of ICD-10 (9) CPT, HCPCS ?Experience with monitoring the proper posting of charges and chart review ?Experience with insurance verification, authorization, claim submission and follow up process. ?Ability to communicate /train staff and providers in new and or proper methods for authorizing care, posting of charges, submitting claims and compliant documentation of visits ?Applicant must have full knowledge of insurance co-pays, deductibles, coinsurance and capitation. ?Broad understanding of Medicare billing, CMS rules PQRS (PQRI) and EHR meaningful use. ?Understanding Medi-cal, Blue View Vision, Private insurance, VSP, Vision Plans, EOB's, payment polices, rules and regulations ?Knowledge of medical coding sufficient to verify completeness and accuracy of coding insurance claims. ?Demonstrated ability to research and find solutions to common billing issues. ?Strong public relations skills and a keen sense of quality customer service. ?Excellent written and verbal communication skills ?The ability to accurately manage detailed information. ?Must be results driven and team oriented. ?Ability to handle sensitive information and maintain confidentiality
The University of California was chartered in 1868 and its flagship campus - envisioned as a "City of Learning" - was established at Berkeley, on San Francisco Bay. Today the world's premier public university and a wellspring of innovation, UC Berkeley occupies a 1,232 acre campus with a sylvan 178-acre central core. From this home its academic community makes key contributions to the economic and social well-being of the Bay Area, California, and the nation.