Job Requisition Number: 26893. As a national collegiate leader, UC Berkeley’s University Health Services (UHS) provides comprehensive medical, mental health, insurance and health promotion services to all Berkeley students, and a variety of health programs for faculty and staff. Approximately 65,000 visits occur annually including Primary Care, Urgent Care, Occupational Health and Specialty Clinics. Services are designed to minimize the impact of illness, emotional distress and injury on studies and work. Coupled with health promotion and public health programs, UHS reaches all segments of the Berkeley campus community. Learn more about us by visiting uhs.berkeley.edu
Cashiering and cash management: reconciliation and quality assurance of all cash receipts and expenses. Change fund: •Collection of expected payments from student/patients for services rendered. •Provide receipts to student/patients for all paid services. •Balance cash drawer on a daily basis. Petty cash fund: Maintain petty cash fund for UHS employees according to campus policy and campus/ UHS procedures.
Customer service: •Maintain current, accurate knowledge of what benefits may be covered at 100% under the Affordable Care Act. •Provide customer service to student/patients who need assistance in resolving issues with their share of cost for services rendered. •Provide customer service to students/patients pertaining to their financial responsibility for services rendered at UHS. •Maintain current, accurate knowledge of Berkeley SHIP policies in order to explain benefits and limitations of the plan to clients when discussing claims. •Verify patient’s Berkeley SHIP enrollment status and work with Berkeley SHIP benefits counselors to determine appropriate claims payment. •Review questions that may arise related to care at UHS and in the community; may include explaining an EOB to a patient and working with carrier to help in resolution. •Claims payment and adjustment calls for other third party payors: accept calls and resolve requests from students who require a copy of their bill on a HCFA form and not in a Walkout Statement form.
Assist in Billing, Reconciliation and Quality Assurance of UHS Claims to Berkeley SHIP and Athletic Insurance: •Assist with submission of claims for payment by Berkeley Student Health Insurance Plan through the claims scrubber to the claims administrator. •Assist in verifying completeness and accuracy of charge captured information. •Using the Practice Management System, generate claims batches and transmit to carrier electronically. •Review claims transaction reports daily to capture detail related to first-blush denials. Identify and make corrections to denials, alerting IT or HIM of chronic denials due to coding selections. Correct rejected claims that result from: no ID number, wrong gender, wrong age, etc. and rebill claims. •Manage pharmacy billing by following through the reconciliation of prescriptions provided to patients in the pharmacy billing system, which flow through to the practice management system. •Review any tickets in the practice management system (open billing) that are stalled in the claims process, i.e. missing detail, empty, charges not capture. May require reviewing medical record / visit notes to understand what charges are appropriate to associate, and appropriate distribution of charges to the plan member v. the insurance carrier.
When called upon, assist the Billing Analyst to: •Post and reconcile payments from insurance carrier through the claims scrubber to open accounts •Identify balances that may be patient responsibility and re-label ticket correctly. Verify balances not payable by insurance program have been billed to CARS in a timely manner •Correct claims where the carrier’s payment may be misaligned with plan design. •Review and resolve any claims that have been on HOLD status to resolve payment or billing issues. •Review and processing of “unauthorized tickets” in a timely manner. •Research and resolve outstanding claims on aging reports for medical, mental health. Aged accounts should not exceed 90 days. •Correct errors in data entry (i.e.; charges applied to wrong visit, incorrect billing codes, etc.)
Assist with Billing to Intercollegiate Athletics insurance program: •Review tickets to verify when claims should be directed to the althetic insurance program v. the general SHIP. •Ensure that insurance carrier “Intercollegiate Athletics (IA) Dept is assigned •Generate invoice for submission to Intercollegiate Athletics (IA) Dept. •Post payments to visits in the electronic medical records system upon receipt of payment to UHS for IA/UC claims. •Reconcile IA billing by researching and resolving outstanding balances for services provided under the scope of the athletic program.
Quality Assurance, Reconciliation and Aging of all visits in the Practice Management System, regardless of Berkeley SHIP status. •Annual Flu Clinic Management: capture all non-SHIP flu vaccine fees.
Record keeping and documentation of billing and payments: •Maintain accurate, organized records of all billing transactions including those related to claims corrections (overpayments, underpayments and denials). •Adhere to UHS policies and procedures for billing records retention. •Maintain accurate documentation of billing operations in the Student Health Insurance Office Manual, updating written procedures as needed.
Accept Electronic Funds Transfers: •Manage the daily electronic funds transfers that come through claims scrubber to the campus, maintaining the detail on the S:SHIO/Bank Deposit shared space.
Checks and remittances from other third party payors: •Accept insurance payments from other third party payors as needed to determine if the payment is meant for UHS or if the payments assignment of benefits needed to go to the patient.
Other duties as assigned.•Employment experience in the health insurance industry, such as customer service, benefits counseling or claims processing. •Direct experience with, or knowledge of, medical claims processing for a major medical health insurance plan. •Knowledge of medical coding sufficient to verify completeness and accuracy of coding on insurance claims. •Uphold high standards of customer service in a demanding and complex health care organization. •Excellent communication skills, both written and verbal. •Excellent research and problem-solving skills. •Ability to function under fluctuating workloads, with frequent distractions and interruptions, and complete heavy workloads within established time frames. •Strong organizational skills to coordinate multiple, varied billing processes simultaneously. •Demonstrated strong interpersonal skills to build effective, professional working relationships with a diverse student customer service base, and diverse staff in a complex organizational structure. •Ability to handle sensitive information (HIPAA/FERPA) and to maintain confidentiality. •Well-developed touch typing/computer skills. •Functional knowledge of Practice Management System, Windows NT and the Microsoft Office suite, including word-processing, spreadsheet, and database programs. •Ability to pay attention to and manage detailed insurance information. •Demonstrated initiative, resourcefulness, integrity and dedication to timeliness to achieve high customer satisfaction levels. •High school diploma or equivalent experience. Employment is contingent on successful completion of: Background Check, Acceptable Medical Evaluation that includes infectious disease surveillance and proof of current required vaccinations or immunity levels, and successful credentials verification (if applicable).
The University of California was chartered in 1868 and its flagship campus - envisioned as a "City of Learning" - was established at Berkeley, on San Francisco Bay. Today the world's premier public university and a wellspring of innovation, UC Berkeley occupies a 1,232 acre campus with a sylvan 178-acre central core. From this home its academic community makes key contributions to the economic and social well-being of the Bay Area, California, and the nation.