Insurance Billing Specialist (Transplant) - Patient Accounting

The Transplant Billing Specialist reports directly to the Billing Supervisor in the Patient Accounting Department. Maintains current understanding of specialized (Global Transplant Billing process), payer-specific, transplant billing requirements for the purpose of billing claims in accordance with contract agreements, for all government and non-government payers. Responsible for daily review and resolution of claim edits in the billing scrubber ensuring claims are billed within 48 – 72 hours of creation date. Ensures all transplant accounts are coded with the proper health plan to ensure claims are routed to the correct payer. Works with internal clinical areas, coding department, and outside payer contacts to collect all data necessary to bill claims in the most accurate manner to optimize reimbursement. Responsible for coordinating related rebill requests from internal and external areas (collections, auditors, customer service, HIM, vendors, payers). Conducts all duties in a professional and timely manner.
Essential Duties

• Daily review and resolution of claim edits in the billing scrubber; review of medical charts for accuracy of transplant date; review of payer specific billing guidelines, up to and including review of contracts, and calling payers.
• Review and ensure accounts are in the proper health plan (payer) according to eligibility and patient insurance card.
• Manual claim splitting based on contract specific stipulations; manual creation of itemize bills to match split claims.
• Collaborates with internal units to obtain invoices and any other claim attachments.
• Collaborates with USC Care Medical Group for obtaining professional claims for Global Billing periods.
• Performs contract reimbursement calculations; prepares payer-specific Global Billing coversheets in collaboration with Collections Supervisors and Leads.
• Works with Transplant department coordinators to obtain clinicals (e.g. mobilization and preparative dates for BMT).
• Collaborates with PFS Management and collections team to resolve billing related denials.
• Monitors held claims for readiness to bill based on global period.
• All other duties as assigned.

Qualifications

• Req High School or equivalent
• Req 3 years Minimum three (3) years’ experience in hospital billing.
• Req Payer Contract interpretation and understanding
• Req Strong knowledge of Transplant billing and collections processes
• Req Strong knowledge of Global Transplant Billing process
• Req Medical terminology
• Req Insurance eligibility and verification
• Req Excel proficiency
• Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)
• Pref Certified Coding Specialist - CCS (AHIMA) Billing and Coding Certificate preferred

USC is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, or any other characteristic protected by law or USC policy. USC observes affirmative action obligations consistent with state and federal law. USC will consider for employment all qualified applicants with criminal records in a manner consistent with applicable laws and regulations, including the Los Angeles County Fair Chance Ordinance for employers and the Fair Chance Initiative for Hiring Ordinance, and with due consideration for patient and student safety. Please refer to the Background Screening Policy Appendix D for specific employment screen implications for the position for which you are applying. 

We provide reasonable accommodations to applicants and employees with disabilities. Applicants with questions about access or requiring a reasonable accommodation for any part of the application or hiring process should contact USC Human Resources by phone at (213) 821-8100, or by email at uschr@usc.edu. Inquiries will be treated as confidential to the extent permitted by law.

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