At the University of California, Berkeley, we are committed to creating a community that fosters equity of experience and opportunity, and ensures that students, faculty, and staff of all backgrounds feel safe, welcome and included. Our culture of openness, freedom and belonging make it a special place for students, faculty and staff.
The University of California, Berkeley, is one of the world's leading institutions of higher education, distinguished by its combination of internationally recognized academic and research excellence; the transformative opportunity it provides to a large and diverse student body; its public mission and commitment to equity and social justice; and its roots in the California experience, animated by such values as innovation, questioning the status quo, and respect for the environment and nature. Since its founding in 1868, Berkeley has fueled a perpetual renaissance, generating unparalleled intellectual, economic and social value in California, the United States and the world.
We are looking for equity-minded applicants who represent the full diversity of California and who demonstrate a sensitivity to and understanding of the diverse academic, socioeconomic, cultural, disability, gender identity, sexual orientation, and ethnic backgrounds present in our community. When you join the team at Berkeley, you can expect to be part of an inclusive, innovative and equity-focused community that approaches higher education as a matter of social justice that requires broad collaboration among faculty, staff, students and community partners. In deciding whether to apply for a position at Berkeley, you are strongly encouraged to consider whether your values align with our Guiding Values and Principles, our Principles of Community, and our Strategic Plan.
Application Review Date
The First Review Date for this job is: 6/10/2021
Berkeley Student Health Insurance Plan (SHIP) is a comprehensive major medical insurance plan, providing medical, counseling, prescription, vision, and dental service. The mission of the Student Health Insurance Office is to provide service to students as it pertains to their health insurance or utilization of University Health Services Center. This includes access to benefit representative to answer any Berkeley SHIP or insurance questions or concerns, cashiering for students to make payments for services render, a Patient Navigator to assist students with more complexed health related issue with authorizations for service and next steps in care, and a waiver department to help with insurance waiver questions and appeals.
The Insurance and Billing Analyst is responsible for the development, implementation and maintenance of processes for managing all aspects of insurance claims payment for in-house services, including verification of payment of fees by clients, preparing claims for electronic submission through the Electronic Medical Record (EMR) system charge capture system to the current insurance carrier, resolving data errors or omissions, reconciling claims submitted to funds received, billing clients for non-allowed claims, refunding students and the current insurance carrier when they are charged/billed in error, assisting with payment collections and processing in the cashiering department, and providing customer service to clients with claims questions or problems.
Assists with researching, developing and implementing new and changing business processes. Develop, implement and maintain systems and procedures for effective, accurate processing of Berkeley SHIP claims for UHS services.
A. Develop and document appropriate financial procedures for reconciliation of fees collected from patients, claims submitted, and claims paid by the Plan, upholding standard accounting procedures and University regulations. Collaborates with Business Operations (Cashier) and Pharmacy managers to implement new procedures and train staff. B. Advise on accuracy of codes based on feedback from the current insurance carrier and the medical coder. Assist in periodic review of codes and coding practices for Medical and Mental Health Services. C. Establish guidelines for customer service in cooperation with other Student Health Insurance Office staff, in order to direct patients with claims questions or concerns to the most appropriate staff for resolution. D. Plan and direct the flow of information between the UHS and the current insurance carrier in accordance with the Electronic Medical Record System EMR system. Partnering with Systems staff, establish electronic transmission of data to and from the current insurance carrier. Ensure proper functioning of the system for daily transactions.
Assists with ensuring financial processing functions which may include Accounts Payable, Accounts Receivable, Cashiering and Collections are performed with accuracy, properly documented within normal accounting principles and that those daily operations run smoothly.
Assists with monitoring the delivery of quality customer service to various constituencies to include internal department clients and external vendors. Participates and/or initiates audits of internal records and processes and prepares recommendations for changes as needed.
Under general supervision, researches and gathers information from a variety of sources; prepares and summarizes information and reports relative to insurance claims processing. Functions as a resource to support staff on issues such as researching complex financial discrepancies, escalated customer service problems and vendor concerns.
Acts as subject matter expert on the current EMR system for billing and collections.
Oversee the preparation, submission and reconciliation of claims, using electronic data transfer systems.
A. Review Electronic Remittance Advice (ERA) encounter tickets daily for completeness and accuracy for timely adjudication by the current insurance carrier. Analyze all claims received for payment by Student Health Insurance Plan through the clearinghouse and the current insurance carrier. 1. Ensure accuracy and completeness of all transaction information. 2. Notate all claims for further review if necessary. 3. Group transactions into batches and submit electronically to the current clearinghouse for claims processing. 4. Ensure daily submission of claims through the clearinghouse in order to maintain cash flow to UHS accounts.
B. Resolve errors or omissions in claims information reported by the clearinghouse or the current insurance health plan via an electronic file daily. 1. Research and resolve problems when errors or omissions are reported in claims data by the current clearinghouse or the current insurance carrier, for example: a) Verify enrollment in Berkeley SHIP through the current insurance broker's website. b) Review with the medical coder coding errors or omissions (CPT, ICD-10-CM, HCPCS).
C. Receive payment from the current insurance carrier by electronic fund transfer through the current clearinghouse for claims and reconcile to original fee transactions. 1. Download Electronic Remittance Advice (ERA) files into the current EMR system and generate posting report. 2. Verify that all ERA data is accurately posted into the current EMR system. 3. Reconcile and document amount of funds transmission from the current insurance carrier to the amounts submitted in batches. 4. Document and report all reasons for rejected/denied, overpaid or underpaid claims. Determine if claims were denied in error and need to be re-submitted for payment. 5. Work with the current insurance carrier's liaison to resolve claims denied in error and to develop and document resolutions for correct billing if we were in error. 6. Request and process refunds to students to correct overpayments made by the students. 7. Request and process refunds to the current insurance carrier to correct overpayments.
D. Assist the cashier in transferring patient responsibility charges to the student's CalCentral accounts from the current EMR system for charges not covered by Berkeley SHIP or Non-SHIP students.
E. Maintain Aged Claims at less than 90 days 1. Track, Analyze, and resolve outstanding claims on aging reports for all claims in the current EMR system (excluding any Workers Comp Claims). 2. Keep aged claims in the current EMR system under 90 days. 3. Correct errors in data entry (i.e.; charges applied to wrong visit, incorrect billing codes etc.) 4. Create a monthly aging report will show all unpaid claims greater than 90 days past the date of service.
F. Provide customer service to patients experiencing problems with Berkeley SHIP, Claims billing, and/or Cashiering. 1. Maintain current, accurate knowledge of Berkeley SHIP policies in order to explain benefits and limitations of the plan to clients when discussing claims. 2. Verify patient's Berkeley SHIP enrollment status and work with Berkeley SHIP benefits counselors to determine appropriate claims payment. 3. Review questions that may arise related to care at UHS and in the community, which may include explaining an Explanation of Benefits (EOB) to a patient and work with the current insurance carrier to help in resolution if needed. 4. Assist in collecting patient payments in all forms, cash, checks, money orders, and credit/debit cards
G. Prepare monthly reports for campus General Accounting for reconciling balance in UHS receivables account to balance in EMR system. Applies professional financial and accounting concepts to independently perform analyses of moderately complex financial services such as researching discrepancies and compliance with external regulations and internal policies.
Assess the impact of UHS policies and procedures on the UC Student Health Insurance Plan, and the impact of changes in Berkeley SHIP benefits and procedures on provision of health services, and act pro-actively to improve systems for the benefit of plan enrollees and UHS staff.
A. Participate in strategic planning for Berkeley SHIP with plan administrators, representing issues such as the effect of the Berkeley SHIP benefits package and claims experiences on plan enrollees. B. Actively work to identify and improve systems throughout UHS that directly or indirectly impact the effective processing of claims or that have a financial impact on the plan. Prepares reports & analyses data to include summaries of financial transactions, evaluation of current and proposed services, etc., for management review and decision-making.
A. Assesses and recommends changes to maintain compliance with federal and state requirements and internal financial/audit policies. B. Participates in audits of internal records and processes and prepares recommendations for changes as needed. C. Documents processes and procedures for financial activities and maintains, updates Billing Manual for the Student Health Insurance Office. D. Reviews, processes, and approves standardized financial data and transactions. Other duties as assigned
Direct experience with, or knowledge of, claims processing for a major medical health insurance plan.
Working knowledge of medical coding (CPT, ICD-10-CM, HCPCS) sufficient to verify completeness and accuracy of coding on insurance claims.
Working knowledge of standard accounting procedures, financial reconciliation and auditing processes.
Experience with the management of clinical data, including collection of data elements, verification of data integrity, querying databases to extract data, and reporting information in a useful format.
Strong critical thinking ability, attention to detail, ability to multi-task in a high-volume environment, organizational skills, sound judgment and decision-making skills.
Demonstrated excellent analytical skills.
Excellent communication skills, both written and verbal.
Demonstrated strong interpersonal skills to build effective, professional working relationships with a diverse clientele and staff.
Experience with project management, as demonstrated by ability to organize, coordinate and complete projects effectively and within deadlines.
Expert user of Windows NT and the Microsoft Office suite, including word-processing, spreadsheet systems, and database programs. Experience working with clinical information systems such as Point N Click.
Experience upholding high standards of customer service in a demanding and complex health care organization.
Demonstrated initiative, resourcefulness, ability to set priorities, innovation and creativity in problem-solving.
Ability to provide effective coaching and mentoring to support staff.
Bachelor's degree or combination of equivalent training and relevant work experience
Minimum four years of experience working in health care or insurance plan administration.
Familiarity with University of California financial regulations desired.
Salary & Benefits
Hiring Range: $24.14 - $34.87 per hour. For information on the comprehensive benefits package offered by the University visit:
Please submit your cover letter and resume as a single attachment when applying.
Employment is contingent on successful completion of: Background Check, Acceptable Medical Evaluation that includes infectious disease surveillance and proof of current required vaccinations or immunity levels, and successful credentials verification (if applicable).
Conviction History Background
This is a designated position requiring fingerprinting and a background check due to the nature of the job responsibilities. Berkeley does hire people with conviction histories and reviews information received in the context of the job responsibilities. The University reserves the right to make employment contingent upon successful completion of the background check.
This position has been identified as a Mandated Reporter required to report the observed or suspected abuse or neglect of children, dependent adults, or elders to designated law enforcement or social service agencies. We reserve the right to make employment contingent upon completion of signed statements acknowledging the responsibilities of a Mandated Reporter.
Equal Employment Opportunity
The University of California is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. For more information about your rights as an applicant see:
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.