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OPS Billing Compliance Specialist

Company: Dignity Health
Location: Stockton
Posted on: May 3, 2021

Job Description:


St. Joseph's Medical Center 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 consumers.


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 programs.
  • Ability to work independently.
  • Excellent communication and interpersonal skills.
  • Skilled in time management and prioritization of emergent situations.
  • Good customer service skills, always demonstrates professionalism.
  • Comfortable utilizing critical thinking skills.
  • Ability to perform mathematical computations and compute ratios and percentages.
  • Ability to examine documents for accuracy and completeness.
  • Ability to maintain confidentiality of sensitive information.
  • 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 surgical setting.
  • Prefer previous experience with Electronic Health Record system, but will train.
  • Prefer previous experience working with Advantx. (Patient Accounting System).
  • RHIT preferred.

Keywords: Dignity Health, Stockton , OPS Billing Compliance Specialist, Other , Stockton, California

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