Only the job description changed.
| Previous Job Description | Current Job Description | ||||
|---|---|---|---|---|---|
| n | 1 | Job Description: | n | ||
| 2 | The Electronic Data Interchange (EDI) Claims Assistant will work in the EDI unit and will be respons | 1 | The Electronic Data Interchange (EDI) Claims Assistant will work in the EDI unit and will be respons | ||
| > | ible for all aspects of EDI production for UCSF Health Patient Financial Services (PFS), Medical Gro | > | ible for all aspects of EDI production for UCSF Health Patient Financial Services (PFS), Medical Gro | ||
| > | up Business Services (MGBS), UCSF Benioff Children’s Hospital Oakland (BCH Oakland), By the Bay Heal | > | up Business Services (MGBS), UCSF Benioff Children’s Hospital Oakland (BCH Oakland), By the Bay Heal | ||
| > | th, UCSF Physicians Group, Community Connect clinic, and Community Hospitals. The EDI production sup | > | th, UCSF Physicians Group, Community Connect clinic, and Community Hospitals. The EDI production sup | ||
| > | ports all electronic claim production to various payers and clearinghouses, including Medicare, Medi | > | ports all electronic claim production to various payers and clearinghouses, including Medicare, Medi | ||
| > | -Cal, Medi-Cal MC, Anthem Blue Cross, Blue Shield, Availity, Optum IEDI, Optum Exchange, Jopari, PNT | > | -Cal, Medi-Cal MC, Anthem Blue Cross, Blue Shield, Availity, Optum IEDI, Optum Exchange, Jopari, PNT | ||
| > | , and Office Ally. Electronic claim generation represents approximately 95% of all claims productio | > | , and Office Ally. Electronic claim generation represents approximately 95% of all claims production | ||
| > | n. Monthly claims volume processed can reach up to 150,000 claims for hospital billing and up to 400 | > | . Monthly claims volume processed can reach up to 150,000 claims for hospital billing and up to 400, | ||
| > | ,000 claims for professional billing. The position also supports the Electronic Remittance Advice (E | > | 000 claims for professional billing. The position also supports the Electronic Remittance Advice (ER | ||
| > | RA) processes for UCSF, MGBS, LPPHC, BCH Oakland, BTBH, UC Physician Group, Community Connect Partne | > | A) processes for UCSF, MGBS, LPPHC, BCH Oakland, BTBH, UC Physician Group, Community Connect Partner | ||
| > | rs, and Community Connect Hospitals. In addition, this position also supports Electronic Funds Trans | > | s, and Community Connect Hospitals. In addition, this position also supports Electronic Funds Transf | ||
| > | fer (EFT) processes for UCSF, MGBS, BCH Oakland, LPPHC, UCPG, and Community Hospitals. The ERA/EFT r | > | er (EFT) processes for UCSF, MGBS, BCH Oakland, LPPHC, UCPG, and Community Hospitals. The ERA/EFT re | ||
| > | epresents approximately 80% of all inbound payment transactions to all supported service areas. Freq | > | presents approximately 80% of all inbound payment transactions to all supported service areas. | ||
| > | uent contact with all units in Patient Financial Services and other billing groups, as well as outsi | ||||
| > | de entities, such as Health Plans and EDI Clearing Houses, which partner with UCSF in EDI processes. | ||||
| > | Frequent access to the following applications: EPIC/APeX, Wells Fargo CEO portal, Clearinghouse EDI | ||||
| > | portals, ApplicationXtender, Cirius’ Billing and Remittance Applications, and various payer sites. | ||||
| 3 | 2 | ||||
| t | 4 | Qualifications: | t | 3 | Frequent contact with all units in Patient Financial Services and other billing groups, as well as |
| > | outside entities, such as Health Plans and EDI Clearing Houses, which partner with UCSF in EDI proce | ||||
| > | sses. Frequent access to the following applications: EPIC/APeX, Wells Fargo CEO portal, Clearinghous | ||||
| > | e EDI portals, ApplicationXtender, Cirius’ Billing and Remittance Applications, and various payer si | ||||
| > | tes. | ||||
| 5 | Requirements: - High school graduate or GED certificate. - One or more years of EDI/ERA experience i | ||||
| > | n a hospital billing office or vendor environment with experience in 837I, 837P, and 835 file types. | ||||
| > | - Three or more years of related administrative experience. - An in-depth understanding of all aspe | ||||
| > | cts of electronic billing. - Good analytical and organizational skills, interpersonal, verbal, and w | ||||
| > | ritten communication skills. - Experience in computer operations, particularly file management and F | ||||
| > | TP processes. - Knowledge of electronic billing systems (i.e., NGS online system, Cirius Prebill, an | ||||
| > | d Remittance Manager, etc.). - Basic knowledge of the Epic (APeX) systems. - Ability to follow direc | ||||
| > | tions and written procedures. - Must be a motivated individual with a positive attitude and exceptio | ||||
| > | nal work ethic. - Maintain a working knowledge of copy and fax machines. - Excellent knowledge of Mi | ||||
| > | crosoft Excel and Access. - Basic knowledge of FTP functions. - Computer software skills (i.e., Micr | ||||
| > | osoft Office Suite). - Knowledge of the mandated HIPAA regulations for security, PHI, and confidenti | ||||
| > | ality is essential. - Ability to work in Emeryville one day a week or more when required. - Ability | ||||
| > | to legally work in the USA without any type of work Visa sponsorship. Preferences: - Insurance payme | ||||
| > | nt posting experience. - Understanding of ICD10, CPT4, HCPCS, and DRG. - Knowledge of insurance bill | ||||
| > | ing contracts, workers’ compensation, HMOs, PPOs, capitation, Medicare, Medi-Cal, and HIPAA complian | ||||
| > | ce program regulations. | ||||