Collections Follow Up Representative

The anticipated duration of this assignment is approximately six months. Will include optional medical coverage, holiday pay, sick leave accrual and vacation accrual. After initial training, this position will be hybrid, with the ability to go on site in Emeryville about once per month as needed.

The Government, Commercial, Contract and Managed Care (CCMC) Units are responsible for the accounts receivable, billing, and follow-up of all government or commercial, contract and managed care payers. The units deal regularly with complex policy and procedural issues that involve contract compliance with regard to Medicare, Medi-Cal, CCS, HMO and PPO payers. It is the units’ responsibilities to communicate and to coordinate throughout various UCSF Medical Center departments, including the UCSF billing agents to ensure the quality of the university’s billing process.

Duties to Include:

• Examines and evaluates accounts for appropriate follow-up action consistent with guidelines and documentation protocols prescribed in the SRG (Situation Response Guide).
• Make daily inquiries on unresolved invoices by phone or via the internet.
• Interpret account information and enter important details to provide an audit trail for further follow up.
• Research missing payments by reviewing EOB (Explanation of Benefits), APEX and RMS.
• Review of non-payment and/or incorrect payment for possible appeal. This may include, but is not limited to the use of the following reference tools and guidelines:
  • CCI edits
  • UCSF Contract Report
  • Profee Grid
  • Medicare Fee Schedule
  • Cascading guidelines
  • CPT, ICD-10, HCPC, Medical Terminology Manuals.
• Analyze Explanation of Benefits (EOBs) for accurate posting of rejection, adjustment and other posting requirements needed in APEX.
• Adheres to the rules and regulations of the different types of payers such as Medicare, Medi-Cal, CCS, PPO, EPO, HMO, and commercial insurance.
• Initiate Charge Correction request.
• Submit requests to department via RFI (Request for Information) process and review response for appropriate action.
• Retrieve all required information needed in order to evaluate correct credit balance and/or correct refund payee.
• Complete and submit refund request with detailed back-up to the unit manager for approval.
• Effectively communicate with MGBS peers, payers, patients, UCSF departments Leads, Assistant Managers and managers. .
• Utilize knowledge of various systems including, but not limited to:
  • Microsoft Word, EXCEL, Outlook, APEX, Payor Web Portals, Health Logic, government and/or non-government websites, and any other information systems which would be required for insurance eligibility, benefit verification or other information needed during detailed follow-up.
• Other Follow Up Duties May include:

• • Secure guarantor/patient demographic and /or insurance information as required.
  • Process correspondence as required in accordance with departmental procedures.
  • Billing or rebilling corrected claims.
  • Create Orthopedic DME (Durable Medical Equipment) Invoice form for DME billing attachment
• Notify manager of possible procedural change for improving efficiency.
• Perform other duties as assigned.

The final salary and offer components are subject to additional approvals based on UC policy.
To see the salary range for this position (we recommend that you make a note of the job code and use that to look up): TCS Non-Academic Titles Search (https://tcs.ucop.edu/non-academic-titles)
Please note: An offer will take into consideration the experience of the final candidate AND the current salary level of individuals working at UCSF in a similar role.
For roles covered by a bargaining unit agreement, there will be specific rules about where a new hire would be placed on the range.
To learn more about the benefits of working at UCSF, including total compensation, please visit: https://ucnet.universityofcalifornia.edu/compensation-and-benefits/index.html

• At least 1 year of previous Insurance Follow up experience.
• High school graduation and four years of related administrative experience; or an equivalent
• combination of education and experience
• Demonstrate the Ability to communicate effectively (orally and written).
• Experience with MS Excel, Word and Outlook
• Effective time management and ability to meet deadlines
• Ability to work independently or as needed with a team.
• Ability to meet productivity and quality standards.
• Demonstrates positive attitude and excellent customer service skills.
• Proven ability to coach and mentor staff for optimal results
• Ability to set priorities, goals and objectives
• Demonstrate the ability to perform all aspects of billing and follow-up with superior quality.
• Excellent attendance record.

• Prior working knowledge of the EPIC (Apex) system, especially PB or HB Insurance Follow up Module(s) strongly preferred.
• Prior experience in a medical office environment; strongly preferred
• Knowledge of UC Peoplesoft
• Bachelor's degree in related area and/or equivalent experience/training
• Certified Procedure Coding (CPC) Certified Dental Coding (CDC) Associates or Bachelor’s Degree