Government Specialist II (Hybrid Work Model)

Kpc Global Medical Centers Inc.; Santa Ana (CA); Hybrid; USD 54,000 - 75,000; Full time

Job summary

Kpc Global Medical Centers Inc. is seeking a Government Specialist II for a hybrid work model in Santa Ana, CA. The role focuses on third-party government payer claims submission, edits, and posting adjustments to patient accounts receivable.

The ideal candidate has 2 years of experience in a medical setting, with knowledge of CPT/HCPCS, HIPAA, and billing systems. Strong attention to detail and ability to work on time-sensitive projects are essential.

Qualifications

• 2 years' experience in a medical office or hospital setting.
• Knowledge of CPT, HCPCS, HIPAA, and regulatory compliance.
• Familiarity with billing systems and software applications.

Responsibilities

• Claims submission including primary and secondary claims using billing editor.
• Account follow-up to recover unpaid or partially paid accounts.
• Identify accurate reimbursement amounts and post adjustments.
• Identify over-payments and process refund requests to payers.
• Note all actions taken in account notes with references and details.
• Support time-sensitive projects related to outstanding accounts receivable.

Skills

CPT/HPCS knowledge

Billing systems knowledge

HIPAA/compliance knowledge

Regulatory knowledge

Education

Some college preferred

Tools

Billing software

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Government Specialist II (Hybrid Work Model)

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

3 days ago Requisition ID: 1547

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.

REQUIREMENTS

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 request 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.