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Authorizations/Billing
Ref No.: 18-10320
Location: Emeryville, California
Under the direction of the Revenue Manager and/or supervisor, the biller/auth rep will work independently to resolve billing related issues in APeX (Epic) in order to help maximize payer reimbursement and RVU charge capture. He/she must have basic understanding of healthcare terminology, processes and work flow and healthcare billing/authorizations in order to make good decisions and resolve account issues. The incumbent should also have outstanding people skills, including telephone technique, professional appearance, organizational skills, and communication skills (oral and written).

This position will be responsible for performing detailed review of medical record documentation to answer billing/authorization level questions and will be responsible for working assigned authorization and billing work queues (WQs) on a daily basis to assist in keeping the denials at a minimum. He/she must have the ability to prioritize multiple tasks and work well with all levels of staff including faculty, management and coworkers both within and outside of the unit. This position requires attendance and completion of on-line and in class courses including but not limited to HB/PB APeX, Basic Insurance Concepts and Collecting Patient Information training.


%
of time
Essential Function (Yes/No)
Key Responsibilities
(To be completed by Supervisor)
70% Areas Of Emphasis
1. Manages the Authorization/billing work queues {WQ} in APeX on a daily basis, keeping Authorizations and edits at a minimum by working requests and deficiencies in WQ (The WQ areas include but are not limited to Account, Router WQ, Charge Review WQ, RFI WQs, and Patient WQs)
2. Works and communicates effectively with coworkers and external coders to resolve any billing/charge capture related issues
3. Able to identify and escalate outstanding issues to appropriate supervisor or manager
4. Addresses patient billing questions and triage calls as needed
5. Provides requested documentation such as operative reports, doctor's notes, and insurance info to aid in the reimbursement process
6. Obtains required authorizations of procedures while maintaining current list on those insurances (this includes pre-service, post service retro/modifications and appeals if needed)

7. Contacts insurance companies directly on accounts that may need additional follow up for claim resolution

8. Demonstrates competency in the APEX system
  1. Maintains confidentiality of all patient information
  1. Performs other duties/projects as assigned

15% ADHERES TO POLICIES AND PROCEDURES

1. Acts in accordance with the organization's mission statement
2. Follows established safety, attendance and tardiness policies established by department
3. Provides excellent customer service to patients, co-workers, physicians and others
4. Assures work environment is clean and is a role model by maintaining a professional, neat appearance, adhering to the department dress code policy and displaying hospital identification badge
5. Utilizes hospital/department computers for hospital business only.
6. Participates in and supports performance improvement activities
7. Promotes positive work relationships with peers, supervisors, and others
10% Professional Development/ Performance Improvement
1. Assumes responsibility and accountability for own professional growth and practice. Attends assigned staff development activities
2. Participates in cross training activities when necessary
3. Participates in related performance improvement projects for the department and hospital.
4. Attends required hospital training and in services.
5% LEADERSHIP/SUPERVISION
  1. Demonstrates the ability to work with minimal supervision