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Job Description

An employer is looking for a Professional Biller/Collector in Torrance, CA. This person will be responsible for the reimbursement of claims from various insurance companies. Must have strong knowledge of managed care contracts and have knowledge of current regulatory requirements to ensure prompt and accurate reimbursement.

-Billing Expertise: Demonstrate a thorough understanding of government, commercial, HMO, PPO, and other insurance billing guidelines across multiple states.

-Hospital Experience: Proficient in using the Cerner system for hospital billing processes.

-Reimbursement Knowledge: Understand reimbursement practices for all payers.

-Collaboration with Payers: Work closely with payers to ensure accurate reimbursement and identify and rectify fee schedule load errors or misinterpretations.

-Insurance Eligibility and Coverage: Familiarity with insurance eligibility criteria and coverage benefits.

-Claims Management: Update coverage details and resubmit claims to payers as needed.

-Issue Resolution: Review insurance plan guidelines against patient accounts to identify and address claim processing delays.

-Account Follow-Up: Effectively resolve assigned work queue accounts, including obtaining claim status, responding to insurance inquiries, and conducting necessary research.

-Quality Assurance: Ensure that resolutions meet department standards.

-Late Charges Evaluation: Evaluate late charges (adjustments vs. billing).

-Research and Appeals: Research accounts via payer websites, confirm claims, review itemized bills, medical records, and appeal receipts.

-Underpayment Management: Process adjustments to close accounts after payments are posted and write dispute and appeals for underpayment cases.

We are a company committed to creating inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity employer that believes everyone matters. Qualified candidates will receive consideration for employment opportunities without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, disability, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to Human Resources Request Form (https://airtable.com/app21VjYyxLDIX0ez/shrOg4IQS1J6dRiMo) . The EEOC "Know Your Rights" Poster is available here (https://www.eeoc.gov/sites/default/files/2023-06/22-088\_EEOC\_KnowYourRights6.12ScreenRdr.pdf) .

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Skills and Requirements

- 2+ years experience of professional billing/collections (working for a hospital - not a third party)

-Experience with multi-specialties including Radiology

- Knowledge and experience with managed care, Medicare, PPO, and HMO contracts as well as some workers comp

- Experience with a production of 45+ claims per day

- Very experienced with modifiers -Experience with Cardiothoracic

- Experience with Cerner

- Any applicable certifications null

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal employment opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment without regard to race, color, ethnicity, religion,sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military oruniformed service member status, or any other status or characteristic protected by applicable laws, regulations, andordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or the recruiting process, please send a request to [email protected].