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 Patient Financial Services (PFS) Denials Senior Billing and Follow Up Representative is responsible for performing hospital billing and follow up functions and related activities in support of the revenue cycle and in accordance with applicable Federal, State and local standards, guidelines and regulations. These responsibilities include but are not limited to: resolving claim edits and related errors to produce clean and accurate billing, following up on denied claims in an effort to determine the root cause/status of the denied payment and for tracking/trending denial issues. The PFS Denials Sr Biller is also responsible for tracking/trending and resolving denial issues for assigned payer and/or assigned service line. The Denials Sr. Biller must possess extensive knowledge in Insurance billing, including a wide range of knowledge of ICD10, CPT, HCPCS and other coding principles. General knowledge of medical/surgical terminology. General knowledge of accounting and reimbursement principles. Extensive knowledge of the field requirements related to insurance billing documents and claim forms (especially UB04 hospital billing claim form). The Denials Sr. Biller is responsible to work system generated claims, edits, record requests, resolve denial issues and credit balance accounts. Job standards are expected to be performed at an expert level. The Denials PFS Sr. Biller/Follow up Rep may be required to provide job shadow knowledge sharing with team members as appropriate.

• Experience with hospital billing and collections, including specialty billing, reimbursement follow up, denial and claim rejection trending and follow up.

• Minimum of 4 years of hospital billing and collection experience.

• Extensive knowledge in Insurance claims appeals with extensive experience in use and understanding of coding as well as demonstration of coding guidelines including medical and surgical terminology.

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

• Knowledge of accounting and cash handling principles and various billing documents and claim forms.

• Excellent verbal and written communication skills and able to promote and maintain superb communication in the following relationships: peer to peer, management, third party payors, patients and departments within UCSD.

• The Denials Billing Specialist must demonstrate reliability, communicate constructively, actively listen, function as an active participant, share openly and willingly, cooperate and pitch in to help, exhibit flexibility, show commitment to the team(s), work as a problem-solver, and treat others in a respectful, professional and supportive manner.

• Expertise using Excel, Word and Outlook.

• A self-starter who is accountable and requires minimal direction and supervision; a person who is open to new ideas; and a creative and flexible individual who is comfortable working in a large, complex organization.

• HFMA Certified Revenue Cycle Representative (CRCR) or within 120 Days

• College level course work in billing certification, medical terminology, health, finance, or other relevant subject matter.

• 5 or more years of experience.

• Experience with both hospital and professional services revenue cycle.

• Experience working in Epic Hospital Billing Functionality.

• Experience in academic hospital setting.

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

• Must be able to work overtime if required.

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