Tri-City Medical Center has served San Diego County’s coastal communities of Carlsbad, Oceanside and Vista, as well as the surrounding region for more than 60 years and is one of the largest employers in North San Diego County. Tri-City is administered by the Tri-City Healthcare District, a California Hospital District. As a full-service acute care public hospital with over 500 physicians practicing in over 60 specialties, Tri-City is vital to the well-being of our community and serves as a healthcare safety net for many of our citizens. The hospital has received a Gold Seal of Approval® from the Joint Commission showcasing a commitment to safe and effective patient care for the residents of the community.
Tri-City Medical Center prides itself on being the home to leading orthopedic, spine and cardiovascular health services while also specializing in world-class robotic surgery, cancer and emergency care. Tri-City’s Emergency Department is there for your loved ones in their time of need and is highly regarded for our heart attack and stroke treatment programs. When minutes matter Tri-City is your source for quality compassionate care close to home. Tri-City partners with over 90 local non-profit and community organizations as part of our COASTAL Commitment initiative. Together we are helping tackle some of our communities’ pressing health and social needs.
Position Summary:
Responsible for calling and collecting from insurance companies on inpatient and outpatient account receivables. Demonstrates extraordinary commitment to excellence by adhering to departmental excellence criteria.
Major Position Responsibilities:
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.Responsible for meeting collection goals that are established by the Director and the Patient Financial Services Manager. Perform timely and effective collection effort through the use of telephone contact, written inquires and or appeals to facilitate appropriate reimbursement of inpatient and outpatient hospital accounts. Utilizes QMS to reach daily and weekly goals. Problem solves and responds to routine provider issues; interpret provider contracts for proper claim payment. Reconciling account balances, corrects any errors, including misapplied payments, late charges, interest payments or over payments from the insurance carriers.Reviews accounts for contractual adjustments based on contract loaded in Alliance/AVEGA. Immediately reports discrepancies to management and may assist with “special projects” as assigned. Refers any account requiring further action to the appropriate follow up representative or agency. Use judgment in escalating unresolved issues to management. Coordinate and clearly communicate issues to responsible parties. Continue to stay informed of any changes in regulations, statutes, or contract changes that could impact collection of receivables.Complete daily and weekly volume/productivity management reporting.Researches, identifies, and rectifies any special circumstances affecting delayed payment of accounts, when appropriate.Takes personal initiative to bring forward process/performance improvements as identified. Performs special assigned duties to meet the needs of the department. Workstations, desk and surrounding area to be kept neat, clean and safe for other employee’s to work at any time.
Qualifications:
Requires at least three years of medical insurance billing and collections in patient accounting business office or hospital setting. Experience with the collection and billing of HMO, PPO, Workers Compensation, Indemnity, Medicare and Medi-Cal and other types of insurance for claims reimbursement.Expected production calls up to 40 accounts per day. Medical Terminology, ICD-9, CPT and HCPC coding essential is necessary. Interpretation of health plan contracts as it relates to reimbursement is a must and how to calculate rates from coding to contract. Experience with collector work list and the responsibility of keeping a daily or weekly tab on patient accounts. Persuasive negotiator to be used when calling health plans for payment. Must have strong interpersonal, verbal and written English language skills sufficient to interact effectively with both internal and external contacts. Triaging of accounts before following up with the insurance carrier to determine what is necessary to get the claim paid. Must be able to work with other professionals and license personnel to resolve issues and make certain decision with the scope of the position.Must have experience in a Windows environment, able to create a spreadsheet, letters and documents using Microsoft Office to include Microsoft Word and Excel. Must know how to use the Internet as it relates to the follow up of insurance payments on the health plans websites. Must know how to use Microsoft Outlook for internal and/or must have the ability to read, understand and interpret correspondence from a health insurance plan. Requires typing skills of 45WPM. Excellent human relations’ skills including listening, conflict resolution, coaching, and team building. Must have ability to demonstrate flexibility in response to unexpected change in work volume and hospital staffing needs. Process oriented skills with ability to handle multiple projects simultaneously by prioritizing responsibilities and meeting deadlines required. Ability to ensure the confidentiality and rights of patients and the confidentiality of hospital and departmental documents required.Education:
High school diploma or GED, required. Medical insurance billing experience preferred.
Each new hire candidate who is offered employment must pass a physical evaluation, urine drug screen and pre-employment background checks before starting work.
*Salary/Hourly wage range for this position is posted. Actual pay will be determined based on verified experience as well as internal equity.
TCHD is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex (including pregnancy, sexual orientation, or gender identity/expression), age, marital status, status as a protected veteran, among other things, or status as a qualified individual with a disability.
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