Patient Billing and Collection Rep 3-4 CX

Job Summary

Involves patient, third party, government, physician billing, and/or collections activities. Provides for coordinated processes, procedures, and systems, customer service delivery models, and ensures compliance with internal policy and external agency regulations. Manages insurance reimbursement from third-party billings and government insurance programs. Keeps abreast of the full array of third-party contracts and billing/collections requirements. Incorporates cash posting, accounts receivable management, and financial counseling for securing collections of accounts.

Job Title	Patient Billing and Collection Rep 3 CX	Patient Billing and Collection Rep 4 CX
Job Code	5398	5399
Bargaining Unit	CX	CX
FLSA	Exempt	Exempt
Generic Scope	Experienced professional who knows how to apply theory and put it into practice with in-depth understanding of the professional field; independently performs the full range of responsibilities within the function; possesses broad job knowledge; analyzes problems / issues of diverse scope and determines solutions.	Technical leader with a high degree of knowledge in the overall field and recognized expertise in specific areas; problem-solving frequently requires analysis of unique issues/problems without precedent and/or structure. May manage programs that include formulating strategies and administering policies, processes, and resources; functions with a high degree of autonomy.
Custom Scope	Investigates highly complex claims, evaluates alternative funding sources for patients in need, and proposes procedures and systems in support of efficient workflows and maximization of reimbursement. Typically, the bargaining unit job code should be used for work covered by this title. However, if the position is not covered by the Higher Education Employer-Employee Relations Act (HEERA) due to one of the following reasons—(1) Confidential status, where duties normally require access to confidential information that significantly influences the development of management’s bargaining or grievance positions; (2) employed outside of California at a location with 100 or fewer employees; or (3) Supervisory status, where duties include supervising employees as a regular part of the job—then the position should be listed under the generic title without the “CX” ending.	Leads projects and / or analysts. Develops and implements procedures and systems to support efficient workflows and maximize reimbursement. Typically, the bargaining unit job code should be used for work covered by this title. However, if the position is not covered by the Higher Education Employer-Employee Relations Act (HEERA) due to one of the following reasons—(1) Confidential status, where duties normally require access to confidential information that significantly influences the development of management’s bargaining or grievance positions; (2) employed outside of California at a location with 100 or fewer employees; or (3) Supervisory status, where duties include supervising employees as a regular part of the job—then the position should be listed under the generic title without the “CX” ending.
Key Resp 01	Researches complex billing issues, confirms payers, evaluates benefits coordination, and identifies appropriate plans to ensure payment. Conducts detailed financial screening of benefits and communicates coverage gaps to patients and the clinical team.	Provides expertise on highly complex claims, establishes external partnerships, researches alternative funding sources for patients in need, and meets with patients and families on high-level billing and collections issues.
Key Resp 02	Implements new systems for managing unpaid or underpaid bills and claims, develops metrics and dashboards, identifies workflow gaps, and trains staff on systems or procedural updates.	Researches best practices to develop new billing and collection systems, collaborating with IT to design improved workflows for data management.
Key Resp 03	Analyzes complex financial data and identifies trends in billing and collections functions, including payments, accounts receivable, denials and outstanding account resolution. Summarizes data and presents reports to leadership.	Analyzes highly complex financial data and identifies trends in billing and collections functions and integration of operations. Delivers comprehensive reports and presentations to leadership, including proposals and solutions to maximize revenues.
Key Resp 04	Acts as a resource for billers and collectors, resolving system, procedural, and policy issues, and develops educational materials for patients on authorization, costs, and reimbursement.	Acts as a technical leader on all third party and patient billing and collections issues, including coverage provisions, appeals, hearings, reimbursement formulas, and use of specialized billing and accounts receivable systems.
Key Resp 05	Tracks progress of work, producing metrics and dashboards; analyzes trends and recommends functional modifications to increase efficiencies.	Monitors third-party payor communications, updating managers on policy changes, and serves as the medical center’s liaison with outside collection agencies.
Key Resp 06	Monitors updates in government regulations and third-party carrier requirements. Develops and implements necessary revisions to systems, policies, and procedures to ensure ongoing compliance.	Monitors updates in government regulations and third-party carrier requirements. Develops and implements necessary revisions to systems, policies, and procedures to ensure ongoing compliance.
Key Resp 07	Delivers staff training on billing and/or collections processes, procedures, policies and information systems.	Develops and delivers staff training on billing and collections processes, procedures, policies and systems. Educates management and staff on complex operational issues, billing and collections trends, best practices, and compliance issues.
Key Resp 08	Collaborates with social work and clinical teams to pursue alternate or supplemental reimbursement sources for patients in financial need; follows through until coverage is granted or denied.	Develops and maintains a resource library of community, government, and other support options for patients in need, and prepares written materials for clinical staff, social workers, patients, and families.
Key Resp 09	Arranges complex financial agreements for patients with anticipated financial liabilities.	Arranges complex financial agreements and handles escalated issues for patients with anticipated financial liabilities.
Education	Bachelor’s degree in related area and/or equivalent experience/training.	Bachelor’s degree in related area and/or equivalent experience/training.
Special Condition	Exercise the utmost discretion in managing sensitive information learned in the course of performing their duties. Sensitive information includes, but is not limited to employee and student records, health and patient records, financial data, strategic plans, proprietary information, and any other sensitive or non-public information learned during the course and scope of employment. Understands that sensitive information should be shared on a limited basis and actively takes steps to limit access to sensitive information to individuals who have a legitimate business need to know. Ensure that sensitive information is properly safeguarded. Follow all organizational policies and laws on data protection and privacy. This includes the secure handling of physical and digital records and the proper use of IT systems to prevent data leaks. The unauthorized or improper disclosure of confidential work-related information obtained from any source on any work-related matter is a violation of these expectations.	Exercise the utmost discretion in managing sensitive information learned in the course of performing their duties. Sensitive information includes, but is not limited to, employee and student records, health and patient records, financial data, strategic plans, proprietary information, and any other sensitive or non-public information learned during the course and scope of employment. Understands that sensitive information should be shared on a limited basis and actively takes steps to limit access to sensitive information to individuals who have a legitimate business need to know. Ensure that sensitive information is properly safeguarded. Follow all organizational policies and laws on data protection and privacy. This includes secure handling of physical and digital records and proper use of IT systems to prevent data leaks. The unauthorized or improper disclosure of confidential work-related information obtained from any source on any work-related matter is a violation of these expectations.
KSA 01	Strong knowledge of billing and/or collections processes, concepts, systems, and external regulations. Knowledge of medical terminology and coding.	Thorough knowledge of billing and/or collections processes, concepts, systems and external regulations. Knowledge of medical terminology and coding.
KSA 02	Strong knowledge of revenue regulations and confidentiality issues, private and government insurance, self-pay, collections, reporting, and data management.	Advanced knowledge in multiple billing and accounting systems, including coding, reimbursement calculations, appeals, research, and communication with customers, insurers, and stakeholders.
KSA 03	Strong analytical skills to produce comprehensive reports, and identify trends and variations.	Advanced analytical skills to develop and recommend new systems, workflows and procedures.
KSA 04	Strong interpersonal and customer service skills to effectively collaborate, negotiate terms, and successfully resolve outstanding accounts.	Advanced interpersonal skills to build lasting relationships with payors, collection agencies, attorneys, and patients for effective payment arrangements.
KSA 05	Strong ability to provide recommendations on issues of functionality and operations in billing. Ability to serve as a resource, providing expertise and education to staff and management at all levels.	Advanced ability to advise on billing functionality and operations, serve as a technical leader, and provide expertise and education to staff and management.
KSA 06	Strong computer proficiency in all relevant hardware and software, with a knowledge of spreadsheet and accounting applications, and a variety of specialized billing and insurance systems.	Strong computer proficiency in all relevant hardware and software, with a knowledge of spreadsheet and accounting applications, and a variety of specialized billing and insurance systems.
Environment	Healthcare (hospital, clinical, classroom setting or similar environment as the role requires).	Healthcare (hospital, clinical, classroom setting or similar environment as the role requires).