Insurance Billing Specialist (Transplant) - Patient Accounting - Full Time 8 Hour Days (Non-Exempt) (Non-Union)

The Transplant Billing Specialist reports directly to the Billing Supervisor in the Patient Accounting Department. Maintains current understanding of specialized (Global Transplant Billing process), payer-specific, transplant billing requirements for the purpose of billing claims in accordance with contract agreements, for all government and non-government payers. Responsible for daily review and resolution of claim edits in the billing scrubber ensuring claims are billed within 48 - 72 hours of creation date. Ensures all transplant accounts are coded with the proper health plan to ensure claims are routed to the correct payer. Works with internal clinical areas, coding department, and outside payer contacts to collect all data necessary to bill claims in the most accurate manner to optimize reimbursement. Responsible for coordinating related rebill requests from internal and external areas (collections, auditors, customer service, HIM, vendors, payers). Conducts all duties in a professional and timely manner.

Essential Duties

• Daily review and resolution of claim edits in the billing scrubber; review of medical charts for accuracy of transplant date; review of payer specific billing guidelines, up to and including review of contracts, and calling payers.
• Review and ensure accounts are in the proper health plan (payer) according to eligibility and patient insurance card.
• Manual claim splitting based on contract specific stipulations; manual creation of itemize bills to match split claims.
• Collaborates with internal units to obtain invoices and any other claim attachments.
• Collaborates with USC Care Medical Group for obtaining professional claims for Global Billing periods.
• Performs contract reimbursement calculations; prepares payer-specific Global Billing coversheets in collaboration with Collections Supervisors and Leads.
• Works with Transplant department coordinators to obtain clinicals (e.g. mobilization and preparative dates for BMT).
• Collaborates with PFS Management and collections team to resolve billing related denials.
• Monitors held claims for readiness to bill based on global period.
• All other duties as assigned.

Qualifications

• Req High School or equivalent
• Req 3 years Minimum three (3) years' experience in hospital billing.
• Req Payer Contract interpretation and understanding
• Req Strong knowledge of Transplant billing and collections processes
• Req Strong knowledge of Global Transplant Billing process
• Req Medical terminology
• Req Insurance eligibility and verification
• Req Excel proficiency
• Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)
• Pref Certified Coding Specialist - CCS (AHIMA) Billing and Coding Certificate preferred