At the University of California, Berkeley, we are committed to creating a community that fosters equity of experience and opportunity, and ensures that students, faculty, and staff of all backgrounds feel safe, welcome and included. Our culture of openness, freedom and belonging make it a special place for students, faculty and staff.
The University of California, Berkeley, is one of the world's leading institutions of higher education, distinguished by its combination of internationally recognized academic and research excellence; the transformative opportunity it provides to a large and diverse student body; its public mission and commitment to equity and social justice; and its roots in the California experience, animated by such values as innovation, questioning the status quo, and respect for the environment and nature. Since its founding in 1868, Berkeley has fueled a perpetual renaissance, generating unparalleled intellectual, economic and social value in California, the United States and the world.
We are looking for equity-minded applicants who represent the full diversity of California and who demonstrate a sensitivity to and understanding of the diverse academic, socioeconomic, cultural, disability, gender identity, sexual orientation, and ethnic backgrounds present in our community. When you join the team at Berkeley, you can expect to be part of an inclusive, innovative and equity-focused community that approaches higher education as a matter of social justice that requires broad collaboration among faculty, staff, students and community partners. In deciding whether to apply for a position at Berkeley, you are strongly encouraged to consider whether your values align with our Guiding Values and Principles, our Principles of Community, and our Strategic Plan.
UC Berkeley School of Optometry operates clinics 7 days per week, year-round, providing vision care at more than 70,000 patient encounters per year in 13 primary and specialty care departments. The majority of patients have some form of government or private vision or medical insurance that they utilize for service.
The Billing Department is responsible for executing and coordinating insurance billing activities including the paneling of faculty providers, reviewing medical charts for billing accuracy and compliance, claims submission, payment reconciliation, payment follow-up and resolving patient insurance issues.
Under the supervision of the Billing Manager and collaborating with other members of the billing team the Medical Biller assures that billing and payment processing is completed in a timely, accurate and compliant manner. The position also provides customer service to patients with billing concerns, students with insurance questions and professional feedback to clinic faculty, staff and administration on billing related issues.
Prepare and submit insurance claims to medical and vision insurance providers produce patient statements.
Assist in verifying completeness and accuracy of charge captured information by reviewing daily schedule and charts for appropriateness and completeness of charges, PQRS and Meaningful use data.
Using the Practice Management System, generate and scrub claims taking corrective action in a timely manner.
Generate claims batches and transmit to carrier electronically.
Review claims transaction reports to capture detail related to first-blush denials. Identify and make corrections to denials, alerting Clinic Administration, IT of chronic denials due to coding selections. Correct rejected claims that result from: no ID number, wrong gender, wrong age, etc. and rebill claims.
Review and resolve any claims that have been on HOLD status to resolve payment or billing issues.
Process EOP's and monitor claim and patient payments.
Post payments to visits in the electronic medical records system upon receipt of payment for claims.
Process claim balances to secondary payors or patient balances as required.
Correct and resubmit denied claims as required.
Monitor unpaid claims and follow up with insurance carriers in a timely manner to insure payment.
Monitor delinquent patient accounts and convert to collections as required.
Generate regular reports on the status and completeness of insurance and patient responsible balances, payments, adjustments and write offs.
Assist in training staff, faculty and students in compliant charting and posting of charges.
Provide professional feedback to faculty and staff on data entry or compliance issues that hinder the timely completion of the billing process
Report repeated problems to clinic administration. Maintain fee schedules.
Work with clinic administration and IT department to insure proper maintenance of fee schedules and insurance allowed amounts in Eyecare PM/EMR to insure proper automated posting of charges to patient ledgers. Assist in credentialing/paneling faculty with insurance carriers.
Maintain accurate rosters of providers per insurance carriers as assigned.
Communicate roster status as required to insure patients are scheduled with credentialed providers. Monitor the need to acquire referrals and insurance authorizations.
Monitor appointments for patients with medical PPO or HMO insurance, acquire authorizations and referrals as required.
Communicate patient financial responsibilities to appropriate parties.
Other duties as assigned.
Employment experience in health insurance industry such as customer service and claims processing.
Full knowledge of ICD-10 (9) CPT, HCPCS.
Experience with monitoring the proper posting of charges and chart review.
Experience with insurance verification, authorization, claim submission and follow up process.
Ability to communicate /train staff and providers in new and or proper methods for authorizing care, posting of charges, submitting claims and compliant documentation of visits.
Applicant must have full knowledge of insurance co-pays, deductibles, coinsurance and capitation.
Broad understanding of Medicare billing, CMS rules PQRS (PQRI) and EHR meaningful use.
Understanding Medi-cal, Blue View Vision, Private insurance, VSP, Vision Plans, EOB's, payment polices, rules and regulations.
Knowledge of medical coding sufficient to verify completeness and accuracy of coding insurance claims.
Demonstrated ability to research and find solutions to common billing issues.
Strong public relations skills and a keen sense of quality customer service.
Excellent written and verbal communication skills.
The ability to accurately manage detailed information.
Must be results driven and team oriented.
Ability to handle sensitive information and maintain confidentiality.
High school diploma and/or equivalent experience/training.
At least 2 years of experience in medical billing process including charge entry, payment posting and claim follow-up.
Must be a creative thinker and be able to adjust processes and thinking to changing environments.
Certified Medical Biller or individual with the ability to become certified.
Applicant should possess a strong knowledge of Compulink Advantage (PM/EHR).
Bachelor's degree in related field and/or equivalent experience/training
Salary & Benefits
For information on the comprehensive benefits package offered by the University visit:
Please submit your cover letter and resume as a single attachment when applying.
Employment is contingent upon passing a physical exam.
Conviction History Background
This is a designated position requiring fingerprinting and a background check due to the nature of the job responsibilities. Berkeley does hire people with conviction histories and reviews information received in the context of the job responsibilities. The University reserves the right to make employment contingent upon successful completion of the background check.
This position has been identified as a Mandated Reporter required to report the observed or suspected abuse or neglect of children, dependent adults, or elders to designated law enforcement or social service agencies. We reserve the right to make employment contingent upon completion of signed statements acknowledging the responsibilities of a Mandated Reporter.
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.