Hospital Business Specialist I/II - Patient Accounting

Kern Medical has been a community cornerstone since its founding in 1867. Today, we are an acute care teaching center with 222 beds, offering the only advanced trauma care between Fresno and Los Angeles.  Kern Medical cares for 15,500 inpatients and 125,000 clinic patients a year.  Kern Medical strives to recruit the highest quality candidates, resulting in a high performance workforce that consistently delivers quality patient care.

 Career Opportunities within Kern Medical include many benefits such as:

• New Hire Premium: +6% of base rate of pay, matched up to 6% if contributed to Deferred Compensation Plan.
• A Comprehensive Benefits Package: includes Holidays, Vacation, Medical, Dental, Vision and Life Insurance.

Job Description: Hospital Business Office Specialist I/II - Full Time

Compensation

The estimated pay for this position is $20.1428 to $29.0429. The rates shown include a 6% premium pay (base= $-$ plus 6%). This reflects only a portion of the total compensation package for this position. Additional compensation may be available for this role through differentials, incentives, and bonuses. In addition, this position may be eligible for participation and company contributions into the Kern County Employees’ Retirement Plan.

Distinguishing Characteristics:

Level I:

The Hospital Business Office Specialist I is the first level of the Hospital Business Office Specialist classification series. Incumbents have hospital/healthcare knowledge and experience, and are expected to gain specific knowledge and proficiency in the revenue cycle. Assignments may be made in billing, reimbursement, contracts, or other related revenue areas. This classification is distinguished from Hospital Business Office Specialist II in that the latter performs more responsible, complex assignments. Promotion to Hospital Business Office Specialist II is based upon recommendation of the department head and approval of the Director of Personnel.

Level II:

The Hospital Business Office Specialist II is the second level of the Hospital Business Office Specialist classification series. Incumbents have hospital/healthcare knowledge and experience, and are expected to gain specific knowledge and proficiency in the revenue cycle. Assignments will be made in billing, reimbursement, contracts, or other related revenue areas. This classification is distinguished from Hospital Business Office Specialist I by performance of more responsible, complex assignments.

Essential Functions:

Level I:

• Verifies and processes a variety of financial documents in support of revenue cycle activities.
• Analyzes and reconciles account activity to determine necessary action or corrections; obtains necessary information to resolve identified issues.
• Enters a variety of fiscally related information into databases; maintains fiscal records and files; documents all follow-up pertaining to account resolution within hospital information systems patient financial record.
• Responds to requests for information and inquiries related to revenue cycle programs, processes, policies, and/or other related information; researches customer discrepancies; resolves customer problems.
• Collects payments; receives, processes, and post electronic and manual payments; collects outstanding balances from all payers.
• Researches, reviews, and adheres to all federal. state, and local regulatory billing and collection follow-up guidelines, as well as payer specific guidelines.
• Checks status of claims; identifies and evaluates follow-up problems and issues through receivable work stations; obtains and assembles documentation required for accurate follow-up.
• Investigates claim data to identify and correct payment errors; reviews remittance codes from EOB’s and RA’s to ensure appropriate payment and identify denials or non-payment; directs credit balances and refunds to appropriate department for resolution.
• Performs various adjustments to accounts.
• Compiles and maintains financial and statistical data records; prepares and distributes related reports.
• Performs general clerical duties, which may include opening, sorting, and distributing mail; preparing mailings; maintaining office supplies; filing; and performing other related activities.

Level II:

• Verifies and processes a variety of financial documents in support of revenue cycle activities.
• Analyzes and reconciles account activity to determine necessary action or corrections; obtains necessary information to resolve identified issues; reviews accounts to ensure full reimbursement and collaborates with other revenue cycle functions to identify, analyze, and resolve root causes for underpayment, denials, and other issues.
• Enters a variety of fiscally related information into databases; maintains fiscal records and files; documents all follow-up pertaining to account resolution within the hospital information systems patient financial record.
• Responds to requests for information and inquiries related to revenue cycle programs, processes, policies, and/or other related information; researches customer discrepancies; resolves customer problems.
• Collects payments; receives, processes, and posts electronic and manual payments.
• Collects outstanding balances from all payers.
• Researches, reviews, and adheres to all federal, state, and local regulatory billing and collection guidelines, as well as payer specific guidelines; assists in clarifying language interpretations and compliance terms.
• Checks status of claims; identifies and evaluates follow-up problems and issues; obtains and assembles documentation required for accurate follow-up.
• Investigates claim data to identify and correct payment errors; reviews remittance codes from EOB’s and RA’s to ensure appropriate payment and identify denials or non-payment; directs credit balances and refunds to appropriate department for resolution.
• Performs various adjustments to accounts.
• Compiles and maintains financial and statistical data records; prepares and distributes related reports accordingly.
• Assists with staff training, development, and mentoring as assigned.
• Performs general clerical duties, which may include opening, sorting, and distributing mail; preparing mailings; maintaining office supplies; filing; and performing other related activities.

Other Functions:

• Handles patient correspondence.
• Assists customers with questions and directions; answers and directs telephone calls accordingly.
• Prepares documents for electronic scanning; performs scanning as assigned.
• Files a variety of materials; retrieves files and provides information from files as directed; maintains logs.
• Performs other related duties as assigned.

Employment Standards:

Level I:

High School Diploma, G.E.D. or equivalent and one (1) year of experience in medical billing, or related fiscal experience in a hospital or medical setting OR an equivalent combination of education, training, and experience sufficient to successfully perform the essential duties of the job.

Level II:

High School diploma or GED and two (2) years of experience in medical billing, or related fiscal experience in a hospital or medical setting OR an equivalent combination of education, training, and experience sufficient to successfully perform the essential duties of the job. 

Employees must maintain all health requirements designated by Kern Medical.

Knowledge of:

Hospital (UB04) and professional billing (CMS 1500) claim practices and procedures; state and federal government funding programs such as Medicare, Medi-Cal, California Children’s Services, TRICARE/CHAMPUS, and Workers’ Compensation; commercial insurance payers; billing and reimbursement guidelines and methodologies for state and federal government and non-government payers; medical, insurance, and coding terminology; HIPAA privacy and compliance practices.

Ability to:

Communicate effectively both orally and in writing sufficient to perform the essential functions; read, understand, and apply policies and guidelines pertaining to billing, reimbursement, contracts, and other fiscal activities; obtain information from a variety of sources, including patients and families; use computers and various software to accomplish work; perform various adjustments to accounts; establish and maintain effective working relationships with patients, families, third-party payers and guarantors, and other internal and external customers

Supplemental:

A background check may be conducted for this classification.

All Kern County employees are designated "Disaster Service Workers" through state and local laws (CA Government Code Sec.3100-3109 and Ordinance Code Title 2-Administration, Ch. 2.66 Emergency Services). As Disaster Service Workers, all County employees are expected to remain at work, or to report for work as soon as practicable, following a significant emergency or disaster.

If position responsibilities require driving a personal vehicle, then possession of a current valid California Driver’s License and adherence to the Kern County Hospital Authority Vehicle Use and Driving Standard Policy (ENG-EC-119) is required.

If position responsibilities require driving a vehicle owned, leased or rented by Kern Medical, then possession of a current valid California Driver’s license, a signed authorization for Release of Drivers Record Information and adherence to the Kern County Hospital Authority Vehicle Use and Driving Standard Policy (ENG-EC-119) is required.