Pre-Billing Coordinator - Rev Cycle Billing & Collections - Sharp Tri City - Day Shift - Full Time

300 Sharp HealthCare; United States; On-site; USD 54,000 - 79,000; Full time

Job summary

Sharp HealthCare is seeking a detail-oriented Pre-Billing Specialist to resolve pre-billing edits and ensure clean claim submissions. You will partner with multiple departments, research CPT/modifier issues, and coordinate with pharmacy when Invega is involved.

Strong MS Office skills and HIPAA compliance are required. This role requires at least a HS Diploma and 2 years in charge quality assessment in acute care.

Qualifications

• HS Diploma or equivalent required.
• 2 years experience in charge quality assessment in acute care hospital.
• Familiarity with CPT codes and modifiers.

Responsibilities

• Resolve pre-billing edits to ensure clean claim submission.
• Identify root causes and coordinate with management across departments.
• Review encounters for modifier review and charge accuracy.
• Collaborate with IT on 3M updates and data factors.
• Support cross-functional teams and patient communications as needed.

Skills

MS Office Proficiency

Interpersonal Skills

Independent Work

CPT Codes Knowledge

APC Structure Knowledge

UB Claim Forms

Education

HS Diploma or Equivalent

2 Years Charge Quality Experience

Tools

Craneware

Cerner

3M Updates

Job description

Hours: Shift Start Time: 8 AM Shift End Time: 4:30 PM AWS Hours Requirement: 8/40 - 8 Hour Shift Additional Shift Information: Weekend Requirements: No Weekends On-Call Required: No Hourly Pay Range (Minimum - Midpoint - Maximum): $26.270 - $32.180 - $38.100 This position is covered by a Collective Bargaining Agreement (CBA) with SEIU. This position was originally posted to SEIU members from 09/25/2026 – 10/3/2026. The position is now available to be filled by internal candidates that are not members of the ratified Bargaining Unit or external candidates to Sharp. What You Will Do This position reports directly to the Patient Accounting Supervisor and is responsible for working to resolve pre-billing edits which prevent clean claim submission. This position will work to identify root cause and work closely with Management across multiple departments to mitigate reoccurrence. Required Qualifications H.S. Diploma or Equivalent 2 Years experience in the performance of charge quality assessment in an acute care hospital. Preferred Qualifications Associate's Degree Bachelor's Degree Essential Functions The position characteristics reflect the most important duties, responsibilities and competencies considered necessary to perform the essential functions of the job in a fully competent manner. They should not be considered as a detailed description of all the work requirements of the position. The characteristics of the position and standards of performance may be changed by TCMC with or without prior notice based on the needs of the organization. Maintains a safe, clean working environment, including unit based safety and infection control requirements. Access multiple reports daily to identify encounters hitting delinquent data and/or placed on hold for research by a collector and/or member of management within the department. Pre-Billing Work all encounters hitting an APC/OCE edit daily by performing the necessary research, applying the correct modifier, adding/removing a charge if necessary and/or following-up with the department for assistance if required. Review accounts pending Modifier review by accessing Craneware and determining the necessity of the requested modifier and/or review the exception to determine if a charge could possibly be missing creating the issue. Review 'LWOT' encounters in Cerner to determine if the patient was seen by a Physician’s Assistant and/or Physician while in Triage to determine the appropriateness of billing the encounter. Research MUE edits to determine if the code hitting the edit is packaged with a maximum quantity allowed, crediting any overage. Retrieve and email all encounters requiring review by Key Healthcare for OPOBS charging daily. Retrieve Missing ED Charge report monthly and determine if there is a missing emergency room charge and/or a missing procedure code. Work with KHC and/or HIM to determine next steps. Re-abstract encounters daily that have been placed on hold to ensure the appropriate APC/DRG/APR-DRG is reflected on the encounter. Identify encounters in which Invega is administered and coordinate charging with the Pharmacy prior to the bill dropping. Updating/Reabstracting encounters to provide Self-pay rates as needed. Other assigned duties pertaining to pre-billing edits, charge capture and AR as required. Work closely with IT to ensure 3M updates are current and factors correct. Cross Function Works in collaboration with the collectors and/or billers to review any encounters with an edit/denial that may have an issue outlined above. May assist in patient calls as well as place follow-up calls to insurance carriers. Training of new hires as necessary to ensure an understanding. Practice Requirements Ensures that patient confidentiality is always protected, both audible and visible Ensures compliance with all medical practice regulations, such as, but not limited to HIPAA and OSHA Knowledge, Skills, and Abilities Proficiency in Microsoft Office, including Word, Outlook and Excel. Excellent interpersonal skills, including written and oral communication. Ability to work independently with strong attention to detail. Understanding of computer systems and their capabilities pertaining to coding, billing and grouper software. Knowledge of compliance concerns relative to coding, billing, reimbursement and documentation. Knowledge of CPT codes and modifiers, charge capture, communication changes in APC’s that may impact charging practices. Knowledge of APC structure, UB claim forms and hospital billing structure. Must be able to read and write in English. Must have ability to demonstrate flexibility and prioritize work load. Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class Sharp HealthCare is a not-for-profit health care system based in San Diego, California, with four acute care hospitals, three specialty hospitals, three medical groups and a health plan. We provide medical services in virtually all fields of medicine, including primary care, heart care, cancer, orthopedics, women’s health, rehabilitation, robotic surgery and bariatric surgery. Sharp sets the community standard for exceptional care. Sharp Grossmont Hospital and Sharp Memorial Hospital have received prestigious Magnet recognition by the American Nurses Credentialing Center for excellence in nursing practices and quality patient care. At the heart of our organization are more than 18,000 affiliated physicians, nurses, staff and volunteers who are on a journey to make health care better for our patients and their families. It’s what we call The Sharp Experience – treating each person with dignity, compassion and respect, and using our clinical excellence and advanced technology to deliver the highest-quality patient care. We are dedicated to transforming the health care experience by making Sharp the best place to work, the best place to practice medicine and the best place to receive care in San Diego.