Government Specialist II (Hybrid Work Model)

Hemet Global Medical Center; Santa Ana (CA); Hybrid; USD 36,000 - 50,000; Full time

Job summary

Hemet Global Medical Center in Santa Ana, CA seeks a Government Specialist II to handle government payer claims submission, follow-up on unpaid accounts, and charge/billing accuracy within a hybrid work model.

The role requires 2 years in a medical office setting, knowledge of CPT/HCPCS/HIPAA, and experience with billing systems. Strong attention to detail and timely processing are essential for success.

Qualifications

• 2 years of experience in a medical office or hospital setting.
• Some college preferred.
• Knowledge of CPT, HCPCS, HIPAA, and regulatory issues. (experience directed)

Responsibilities

• Claims submission using billing editor; submits primary/secondary claims.
• Follow-up on unpaid or partially paid accounts; review EOBs and payer communications.
• Identify accurate reimbursement amounts and post adjustments as needed.
• Identify and process refund requests for over-payments to payers.
• Address coding/charging errors and coordinate corrections with the appropriate department.

Skills

CPT Knowledge

HCPCS Knowledge

HIPAA Compliance

Billing software

Education

Some college

Tools

Billing software

Job description

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Government Specialist II (Hybrid Work Model)

Full Time KPC SANTA ANA, Santa Ana, CA, US

Salary Range: $26.00 To $36.00 Hourly

SUMMARY

For governmental third-party payers including Medicare, Medicaid, Medi-Cal, Veterans' Campus, Tri-Care, County, and other governmental payers performs third party bill paper and electronic preparation, editing, and submission to payer, ensures accurate identification of expected reimbursement amounts. Calculates and posts adjustments and write-off transactions to patient accounts receivable, collection, unpaid account follow-up, patient account analysis, preparation of appeals, identification of over-payments, initiating and processing refund request to third party payers. Escalates recurring issues preventing the effective and efficient processes needed for goal attainment.

RESPONSIBILITIES AND DUTIES:

• Claims submission. Responsible for ensuring timely submission of governmental claims in billing editor. On a daily basis prepares and submits primary and secondary claims using the billing editor software to submit claims electronically or hardcopy, ensuring all edits are worked in a compliant manner based on directives given by management.
• Account follow-up. Responsible for collection of unpaid or partially paid accounts by utilizing ATB reports, review of EOB’s and correspondence received from payers and taking appropriate action to resolve any issues and secure correct payment due including timely filing of appeals.
• Identification of accurate efficient reimbursement amount & posting appropriate adjustments as required.
• Identification of over-payments. Initiating and processing refund requests to third party payers in compliance with governmental regulations.
• Coding and charging errors. Ensures all charge and coding related issues are clearly identified & resolved or entered on the appropriate HIM/Charge audit spreadsheet for correction/resolution by appropriate department representation.
• Assists and successfully completes time sensitive projects as it relates to outstanding accounts receivables within the time frame stated by management.
• Maintains productivity levels within guidelines established by management. Receives an at or above team average productivity score.
• Documents clearly and succinctly in account notes all action taken on account. i.e. phone numbers, representative’s name, call reference number, corrective action taken, referrals made and specific claim submission details as appropriate.
• Performs duties with little or no errors. Remains at or above team average quality of work errors.
• Other duties as assigned.

EDUCATION & EXPERIENCE REQUIREMENTS:

• Some college preferred.
• 2 years’ experience in a medical office or hospital setting.

SKILLS & ABILITIES REQUIREMENTS:

• Knowledge of CPT, HCPC’s, HIPAA, Compliance and Regulatory issues.
• Knowledge of billing systems and software applications

PHYSICAL REQUIREMENTS:

Body Positions: Sitting and standing for prolonged periods.

Body Movements: Arm and hand dexterity.

Body Senses: Must have command of close and distant sight, color perception and hearing.

Strength: Ability to lift and move up to 25-pounds.