OPS Billing Compliance Specialist
Company: Saint Joseph's Hospital and Medical Center
Posted on: May 3, 2021
is a member of Dignity Health . The word "dignity" perfectly
defines what our organization stands for, showing respect for all
people by providing excellent care. St. Joseph's Medical Center,
was founded in 1899 under the direction of the Dominican Sisters of
San Rafael, is a not for profit, fully accredited, regional
hospital with 395 beds, a physician staff of over 400, and more
than 2,400 employees. Specializing in cardiovascular care,
comprehensive cancer services and women and children's services
including neonatal intensive care. St. Josephs is the largest
hospital as well as the largest private employer in Stockton,
California. Nationally recognized as a quality lead, St. Josephs is
consistently chosen as the "most preferred hospital" by local
Under the direction of the Business Office Manager, the Billing
Compliance Specialist is responsible for follow up on delinquent
surgery center claims, working an expected number of claims per
day. Majority of claims will have been submitted to various
insurance carriers electronically. Knowledge of how to interpret a
managed care contract, Medicare and Medicaid and Workers
Compensation claims is a must. You will be given tools to calculate
allowable and required to determine appropriateness of
reimbursement and appeal claims as necessary.
Extensive contact with insurance carriers of all types, as well as
communication with patients regarding out of pocket amounts is
required. Outbound collection calls to patients regarding their
medical/invoice bill answering questions and setting up
payment/payment plans Identification of accounts that have been
either under or over paid, issuing credit balance information
either to the insurance carrier or the patient. All of these
practices done in a professional and communicative manner, per
policies and procedures, guidelines, internal control measures and
established goals. .
Candidate must be a team player, and have ability to communicate
well with direct reports, patients, customers, insurance carriers,
etc. Ability to manage accounts worked independently, and in a
productive manner. Must project a professional demeanor and
appearance while maintaining the confidentiality of the surgery
center and patients. Works well in stressful environment and in
situations that demand patience.
Projects a professional demeanor and appearance while maintaining
the confidentiality of administration, patients, physicians and
employees. Works under stress and in situations that demand
patience and tact while providing impeccable service.
- 3-4 years previous collections experience, with emphasis on
healthcare insurance collections of all types.
- Experience with electronic patient information systems.
- Strong Medical terminology.
- Typing 45-60 WPM.Capable of operating 10 key calculator.
- Proficient with Microsoft Office products.
- Demonstrated proficiency in the most current coding conventions
on ambulatory surgery medical records.
- Knowledge of third party billing, including Medicare, Managed
care, commercial, Worker's compensation and state Medicaid
- Ability to work independently.
- Excellent communication and interpersonal skills.
- Skilled in time management and prioritization of emergent
- Good customer service skills, always demonstrates
- Comfortable utilizing critical thinking skills.
- Ability to perform mathematical computations and compute ratios
- Ability to examine documents for accuracy and
- Ability to maintain confidentiality of sensitive
- Skill in establishing and maintaining effective working
relationships with other employees, patients, clients, insurance
organizations, and the public.
- Preference shown to previous experience in an ambulatory
- Prefer previous experience with Electronic Health Record
system, but will train.
- Prefer previous experience working with Advantx. (Patient
- RHIT preferred.
Keywords: Saint Joseph's Hospital and Medical Center, Stockton , OPS Billing Compliance Specialist, Other , Stockton, California
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