Billing Specialist (4722C) Optometry Clinic, #73955

At the University of California, Berkeley, we are committed to creating a community that fosters equity of experience and opportunity, and ensures that students, faculty, and staff of all backgrounds feel safe, welcome and included. Our culture of openness, freedom and belonging make it a special place for students, faculty and staff.

The University of California, Berkeley, is one of the world's leading institutions of higher education, distinguished by its combination of internationally recognized academic and research excellence; the transformative opportunity it provides to a large and diverse student body; its public mission and commitment to equity and social justice; and its roots in the California experience, animated by such values as innovation, questioning the status quo, and respect for the environment and nature. Since its founding in 1868, Berkeley has fueled a perpetual renaissance, generating unparalleled intellectual, economic and social value in California, the United States and the world.

We are looking for equity-minded applicants who represent the full diversity of California and who demonstrate a sensitivity to and understanding of the diverse academic, socioeconomic, cultural, disability, gender identity, sexual orientation, and ethnic backgrounds present in our community. When you join the team at Berkeley, you can expect to be part of an inclusive, innovative and equity-focused community that approaches higher education as a matter of social justice that requires broad collaboration among faculty, staff, students and community partners. In deciding whether to apply for a position at Berkeley, you are strongly encouraged to consider whether your values align with our Guiding Values and Principles, our Principles of Community, and our Strategic Plan.

At UC Berkeley, we believe that learning is a fundamental part of working, and our goal is for everyone on the Berkeley campus to feel supported and equipped to realize their full potential. We actively support this by providing all of our staff employees with at least 80 hours (10 days) of paid time per year to engage in professional development activities. To find out more about how you can grow your career at UC Berkeley, visit grow.berkeley.edu.

Departmental Overview

At the Wertheim School of Optometry & Vision Science, as part of a world-renowned university that embraces excellence and access, we foster an environment of trust and mutual respect, free expression and inquiry, and personal resilience and achievement. We demonstrate sensitivity and understanding of the diverse academic, socioeconomic, cultural, disability, gender identity, sexual orientation, and ethnic backgrounds present in our community. These principles serve us daily in our reasoning and actions and aid us in our decision making.

We educate an estimated 320 students annually. Our O.D. program is a 4 year program with clinical training provided at 2 campus clinics, 10 satellite clinics (community care), 7 VA clinics, and 24 external clinics across the country. Our one-year post-graduate residency programs provide advanced clinical education in specialty areas of optometry with placement on and off campus and our Vision Science program averages 40 PhD students.

The Optometry Clinic provides comprehensive optical care services to the entire Campus population and the general Bay Area community, with approximately 80,000 annual visits to Optometry Clinics at Minor Hall and the Tang Center. The Optometry Clinic is open 7 days per week and approximately 358 days per year.

Application Review Date

The First Review Date for this job is: 11/7/2024

Responsibilities

Reporting to the Billing and Collections Manager, the billing specialist will provide patient, third party, government, physician billing and collections activities.

Key Responsibilities:

Prepare and submit insurance claims to medical and vision insurance providers as well as produce patient statements:

• Assist in verifying completeness and accuracy of charge captured information by reviewing daily schedule and charts for appropriateness and completeness of charges, PQRS, and meaningful use data.
• Using the Practice Management System, generate and scrub claims resolving issues in a timely manner.
• Generate claims batches and transmit to carrier electronically.
• Review claims transaction reports to capture detail related to denials.
• Identify and make corrections to denials, alerting Clinic Administration or IT of chronic denials due to coding errors.
• Resolve issues related to rejected claims and rebill claims.
• Review and resolve any claims that have been on HOLD status to resolve payment or billing issues.
• Send statements to patients.

Process EOBs and monitor claim and patient payments:

• Post payments to visits in the electronic medical records system upon receipt of payment for claims.
• Process claim balances to secondary payors or patient balances as required.
• Correct and resubmit denied claims as required.
• Monitor unpaid claims and follow up with insurance carriers in a timely manner to ensure payment.
• Monitor delinquent patient accounts and convert to collections as required.
• Generate regular reports on the status and completeness of insurance and patient-responsible balances, payments, adjustments, and write-offs.

Follow-up/Collections:

• Conduct follow-up on accounts and evaluate appropriate follow-up actions based on modified account balances assigned through monthly ad-hoc reports to achieve weekly and monthly goals.
• Comply with rules and regulations of different payers such as Medicare, Medi-Cal, HMOs, commercial payers, Workers' Compensation, and government agencies.
• Interpret and enter detailed online notes to understand past activity and provide an audit trail for future follow-up.
• Communicate effectively with payers, patients, clinic chiefs, and outside billing agents.
• Perform all follow-ups necessary to track missing payments and utilize systems such as Compulink, Epic, Microsoft Outlook, and government or non-government websites for detailed follow-ups.
• Coordinate and collaborate with supervisor or manager to resolve and problem-solve billing issues.
• Review non-payment and/or incorrect payments for possible appeal.
• Request restoral of contractual allowances or adjustments to initiate appeals as warranted.
• Prepare appeal letters to payers requesting additional payment and retrieve necessary information to support appeal letters.
• Perform proactive follow-ups for all appeals submitted.
• Analyze Explanation of Benefits (EOB) for accurate posting of rejections, adjustments, and other posting requirements, and notify the manager of refunds, adjustments, and transfers as needed.

Correspondence/Denials:

• Secure guarantor or patient demographic and insurance information as required.
• Respond to and resolve inquiries regarding billing policies, procedures, pricing, and coding.
• Resubmit bills to payers in a timely manner and in accordance with department and payer requirements.
• Process denials according to departmental procedures.
• Retrieve reports or additional information from various sources.
• Prepare appeals on denials as warranted and initiate write-off requests if appropriate.
• Record activity performed for denial processing and maintain records of all denial or appeal processes for tracking and reporting purposes.

Other duties as assigned, which may include the following:

• Assist in credentialing or paneling faculty with insurance carriers.
• Maintain accurate rosters of providers per insurance carriers as assigned.
• Communicate roster status as required to ensure patients are scheduled with credentialed providers.
• Train peers or clinic colleagues (faculty, staff, and students) as necessary.
• Monitor billing email and assist with patient correspondence in a timely manner.

Assist in credentialing or paneling faculty and residents with insurance carriers.

• Maintain accurate rosters of providers per insurance carriers as assigned.
• Communicate roster status as required to ensure patients are scheduled with credentialed providers.
• Coordinate the review of new and separating providers.

Referrals and Insurance Authorizations:

• Monitor appointments for patients with medical PPO or HMO insurance and acquire authorizations and referrals as required.
• Communicate patient financial responsibilities to appropriate parties.

Daily Cash Deposits:

• Reconcile cash, checks, and credit card payments from the previous day to the Eyecare daily payment report.
• Reconcile daily parking tickets to the parking report in Eyecare.
• Prepare deposit reports for internal reporting.
• Prepare deposit bags for the bank and submit deposits to campus following best practices and guidelines.

Required Qualifications

• Thorough knowledge in administrative procedures and processes including word processing, spreadsheet and database applications.
• Requires good verbal and written communication skills, active listening, critical thinking, multi-task and time management skills.
• Requires interpersonal and work leadership skills.
• Previous work experience that required knowledge of physician billing procedures including charge entry, payment posting and claim follow-up.
• Excellent verbal and written language skills.
• Must be reliable, dependable and must have an excellent attendance history
• Full knowledge of ICD-10 (9) CPT, HCPCS.
• EHR experience with platforms such as Compulink Advantage and Epic.
• Experience with insurance verification, authorization, claim submission and follow up process.
• Understanding Medi-cal, Blue View Vision, Private insurance, VSP, Vision Plans, EOB's, payment polices, rules and regulations.
• Must be results driven and customer service oriented.
• Knowledge of security and privacy regulations, HIPAA compliance.

EDUCATION

• Graduation from high school or a GED and a minimum of two years of experience in medical billing and/or equivalent experience/training.

Salary & Benefits

This is a 100% full-time (40 hrs a week) non-exempt career position, which is paid hourly and eligible for full UC Benefits.

For information on the comprehensive benefits package offered by the University, please visit the University of California's Compensation & Benefits website.

Under California law, the University of California, Berkeley is required to provide a reasonable estimate of the compensation range for this role and should not offer a salary outside of the range posted in this job announcement. This range takes into account the wide range of factors that are considered in making compensation decisions including but not limited to experience, skills, knowledge, abilities, education, licensure and certifications, analysis of internal equity, and other business and organizational needs. It is not typical for an individual to be offered a salary at or near the top of the range for a position. Salary offers are determined based on final candidate qualifications and experience.

The budgeted salary or hourly range that the University reasonably expects to pay for this position is $29.63 [Step 1.0] - $33.96 [Step 7.0].

How to Apply

To apply, please submit your resume and cover letter.

Other Information

• This position is governed by the terms and conditions in the agreement for the Clerical & Allied Services Unit (CX) between the University of California and Teamsters Local 2010. The current bargaining agreement manual can be found at: http://ucnet.universityofcalifornia.edu/labor/bargaining-units/cx/index.html
• This recruitment has 4 openings.

Conviction History Background

This is a designated position requiring fingerprinting and a background check due to the nature of the job responsibilities. Berkeley does hire people with conviction histories and reviews information received in the context of the job responsibilities. The University reserves the right to make employment contingent upon successful completion of the background check.

Physical Exam

Employment is contingent upon passing a physical exam.

Equal Employment Opportunity

The University of California is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. For more information about your rights as an applicant, please see the U.S. Equal Employment Opportunity Commission poster.

For the complete University of California nondiscrimination and affirmative action policy, please see the University of California Discrimination, Harassment, and Affirmative Action in the Workplace policy.