Patient Biller III - Hybrid - 135549

UC San Diego Health's Revenue Cycle department supports the organization's mission to deliver outstanding patient care and to create a healthier world - one life at a time. We are a diverse, patient-focused, high-performing team with a commitment to quality, collaboration, and continuous improvement that enables us to deliver the maximum standard of care to our patients. We offer challenging career opportunities in a fast-paced and innovative environment and we embrace individuals who demonstrate a deep passion for problem-solving and customer service.

The Insurance & Patient Biller III is responsible for the full range of billing duties within the revenue cycle-from claim generation to final payment resolution. This role requires advanced knowledge and independent judgment to ensure claims are submitted accurately, followed up on diligently, and resolved in accordance with payer-specific guidelines. The Biller III will monitor, prioritize, and complete all assigned billing tasks, including resolution of claim edits, submission of appeals, processing of rejections, handling of late charges, and working denials. A strong understanding of Medicare Managed Care contracts and accounts receivable (AR) follow-up processes is essential. This position also requires proficiency in using payer portals and electronic medical record (EMR) systems such as Epic

• Three (3) years of recent acute care hospital billing and collection experience.

• Knowledge of medical insurance and State and Federal rules and regulations related to billing Insurance Claims.

• Extensive knowledge in submission of hospital claims appeals and basic knowledge in medical terminology, ICD9, CPT, HCPCS coding principles.

• Knowledge in self -pay collections.

• Knowledge of Hospital payer contracts and reimbursement methodologies including but not limited to per diem, fee schedule, case rate and DRG's.

• Knowledge of UB04 and revenue codes as it pertains to hospital billing.

• Some college coursework or an Associate Degree.

• Prior Epic experience with Resolute Professional Billing.

• Billing Certificate.

• Three (3) years of recent Medicare/Medicare Managed Care experience specifically related to processing and resolving claims within a medical billing environment.

• Three (3) or more years of experience with Medicare Advantage and Medicare Sr. plans.

• Familiar with reading medical records in order to submit records to support medical necessity based on diagnosis and services rendered.

• Clear understanding or know how to properly obtain the different types of payer information timely and how to prioritize workload based on the payer specific info.

• Capable and comfortable with verifying patient coverage/insurance verification and adjudication via a payer portal, Epic system or by phone.

• Ability to identify, analyze, and appeal denied claims with proper documentation.

• Understanding payer reimbursement rules and contract interpretation.

• Skilled in tracking unpaid claims, follow up with payors and ensuring timely resolution.

• Experience working and resolving front and back end edits.

• Hands on experience using Epic and payor portals for eligibility, claim status and appeal submissions.

• Must be able to work various hours and locations based on business needs.

• Employment is subject to a criminal background check and pre-employment physical.