Hospital Business Office Specialist I/II (Auditor/Appeals)

Kern Medical has been a community cornerstone since its founding in 1867. Today, we are an acute care teaching center with 222 beds, offering the only advanced trauma care between Fresno and Los Angeles. Kern Medical offers a range of primary, specialty, and multi-specialty services including high-risk pregnancy care, inpatient psychiatric services integrated with county mental health programs, and a growing network of outpatient clinics providing personalized patient-centered wellness care. Kern Medical cares for 15,500 inpatients and 125,000 clinic patients a year.

Career Opportunities within Kern Medical include many benefits such as:

• New Hire Premium: +6% of base rate of pay, matched up to 6% if contributed to Deferred Compensation Plan.
• Shift Differential Pay: varies per classification.
• A Comprehensive Benefits Package: includes Holidays, Paid Time Off, Retirement, Medical, Dental, Vision and Life Insurance.

Position: Hospital Business Office Specialist I/II (Auditor/Appeals)

Job Description

Under supervision, performs a wide variety of hospital financial services activities, which may include: processing billings, collecting money and preparing deposits, resolving customer problems and providing customer service.

Patient Account Representative experience along with medical professional billing and collections experience preferred.

DISTINGUISHING CHARACTERISTICS:

The Hospital Business Office Specialist I/II classification performs responsible, complex assignments.

Incumbents have hospital/healthcare knowledge and experience, and are expected to demonstrate proficiency and apply specific knowledge in revenue cycle activities.

Essential Functions:

• Verifies and processes a variety of financial documents in support of revenue cycle activities.
• Analyzes and reconciles account activity to determine necessary action or corrections; obtains necessary information to resolve identified issues.
• Enters a variety of fiscally related information into databases; maintains fiscal records and files; documents all follow-up pertaining to account resolution within the hospital information systems patient financial record.
• Responds to requests for information and inquiries related to revenue cycle programs, processes, policies, and/or other related information; researches customer discrepancies; resolves customer problems.
• Collects payments; receives, processes, and posts electronic and manual payments; collects outstanding balances from all payers.
• Researches, reviews, and adheres to all federal, state, and local regulatory billing and collection follow-up guidelines, as well as payer specific guidelines.
• Checks status of claims; identifies and evaluates follow-up problems and issues through receivable work stations; obtains and assembles documentation required for accurate follow-up.
• Investigates claim data to identify and correct payment errors; reviews remittance codes from EOB’s and RA’s to ensure appropriate payment and identify denials or non-payment; directs credit balances and refunds to appropriate department for resolution.
• Serves as a lead to include assigning and monitoring work, training employees on work methods, and providing direction; may supervise staff including conducting performance evaluations and making hiring, disciplinary, and termination recommendations.

Employment Standards:

• Level I - High School Diploma, G.E.D. or equivalent and one (1) year of experience in medical billing, or related fiscal experience in a hospital or medical setting OR an equivalent combination of education, training, and experience sufficient to successfully perform the essential duties of the job.

• Level II - High School diploma, G.E.D. or equivalent and two (2) years of experience in medical billing, or related fiscal experience in a hospital or medical setting OR an equivalent combination of education, training, and experience sufficient to successfully perform the essential duties of the job.

Employees must maintain all health requirements designated by Kern Medical.

Knowledge of: Hospital (UB04) and professional billing (CMS1500) claim practices and procedures; state and federal government funding programs such as Medicare, Medi-Cal, California Children’s Services, TRICARE/CHAMPUS, and Workers’ Compensation; commercial insurance payers; billing and reimbursement guidelines and methodologies for state and federal government and non-government payers; medical, insurance, and coding terminology; HIPAA privacy and compliance practices.

Ability to: Communicate effectively both orally and in writing sufficient to perform the essential functions; read, understand, and apply policies and guidelines pertaining to billing, reimbursement, contracts, and other fiscal activities; obtain information from a variety of sources, including patients and families; use computers and various software to accomplish work; perform various adjustments to accounts; establish and maintain effective working relationships with patients, families, third-party payers and guarantors, and other internal and external customers.

A background check will be conducted for this classification.