Manages and assembles all data and documents required for accurate billing/submission and/or follow-up of claims to HMO, PPO, Workers' Compensation, Medicare, Medi-Cal and other third party payers and guarantors. Billing is performed on all inpatient and outpatient encounters. It includes researching, reviewing and adhering to all federal, state and local regulatory billing guidelines, as well as payer specific billing guidelines. Data specific to each patient account is reviewed and processed in current hospital information systems application for integrity, and then reviewed and processed in current hospital electronic billing system. Daily reconciliation of accounts and credit balances generated based on billing processes. Implements strategies to optimize the total collected value of each patient account via the current hospital information systems applications by appropriate billing and submission of the claim to the appropriate payer who is responsible for the claim. Maintains high productivity and quality with minimal supervision. Works in collaboration with internal and external customers. Customer service and satisfaction are a key standard for all communications. Work will be subject to compliance reviews and productivity standards. Yearly continuing education is required. Speak and read English at a level that is sufficient to satisfactorily perform the essential functions of the position. Knowledge of standard office equipment (i.e., calculator, fax, photocopier) and personal computer and computer software skills (i.e., MS Windows, Excel, Access, Word, Powerpoint, internet, e-mail). Windows computer skills including proficient use of keyboarding, use of mouse or keys for functions such as selecting items, use of drop down menus, scroll bars, opening folders, copying and similar operations required upon employment or within the 1st two weeks of employment to perform the essential functions of the job. Performs other duties as assigned. Follows Palomar Health rules, policies, procedures, applicable laws and standards. Carries out the mission, vision, and quality commitment of Palomar Health.

Job Requirements