Department Overview Responsible for the complete billing, adjustment processing, follow-up, and collection of complex Transplant accounts to ensure timely and accurate reimbursement to University Hospital. This specialized role requires independent management of the entire revenue cycle for high-dollar, high-risk transplant cases, including detailed analysis of accounts, identification of payment barriers, development of resolution strategies, and coordination with multiple internal and external stakeholders.
Function/Duties of Position Billing Manage the specialized billing, claim editing, and follow-up for Transplant claims to ensure accurate, timely, and compliant submission to CCMC payers. Coordinate closely with Professional Billing (PB) to prepare and submit combined invoices and claims during the global billing period. Third party follow-up and collection Within the stratified processing environment, collect assertively and proactively money due OHSU by contacting (through telephoning, emailing, and/or accessing on-line systems) third parties (insurance carrier, various government programs, etc.) Provide explanation of charges and additional requested information to the third parties.
Analyze accounts to determine coordination of benefits, refunds, and denials to insure appropriate resolution of accounts. Review billing to determine medical records necessary to provide complete processing of claim. Analyze accounts with regard to billing and payment history and uses judgment to determines appropriate follow-up action based on departmental guidelines.
Contact patient/guarantor to resolve issues (includes tracing and locating patient/guarantor by telephoning and/or sending written correspondence.) Analyze accounts and interpreting contracts that dictate how claims should be paid and processing adjustments for contract interpretation. Comply with special billing and follow-up requirements regarding adoptions, court holds, motor vehicle and personal injury accidents, and other unique or sensitive accounts.
Prepare the appeals for selected denials. AR Oversight Monitor AR aging and performance through regular reporting and data analysis. Identify systemic issues and proactively escalate with payers to resolve barriers to payment.
Communicate progress, challenges, and trends to Revenue Cycle leadership, Contracting, and clinical departments to support timely resolution and continuous improvement. Other duties as assigned. Required Qualifications 3 years of recent medical collection and/or billing experience.
Work experience must have occurred within 5 years of hire date. Experience in hospital billing and/or UB-04 claims. Knowledge of and experience in interpreting managed care contracts.
Certified Revenue Cycle Specialist (CRCS) is required within 18 months of hire.
Knowledge of and experience in interpreting managed care contracts. Familiarity with DRG, CPT, HCPC and ICD-9 coding. Recent (within one year of date of hire) Microsoft Office Suite experience in Windows environment with skill in document production using WORD, spreadsheet construction in EXCEL.
EPIC certification in HB Resolute preferred. Typing at or above 45 wpm. Ability to use multiple system applications.
Demonstrated ability to communicate effectively verbally or in writing. Additional Details Monday through Friday. 1 day per week in office, otherwise remote position. Deal with hostile, grieving, or angry people on a daily basis.
Benefits Healthcare for full-time employees covered 100% and 88% for dependents. $50K of term life insurance provided at no cost to the employee. Two separate above market pension plans to choose from. Vacation - up to 200 hours per year dependent on length of service.
Sick Leave - up to 96 hours per year. 9 paid holidays per year. Substantial Tri-Met and C-Tran discounts. Employee Assistance Program.
Childcare service discounts. Tuition reimbursement. Employee discounts to local and national businesses.
Why apply to OHSU? We are Oregon's only public academic health center. In addition to caring for patients, we lead groundbreaking research.
We also train the next generation of health care professionals. As Portland's largest employer, we give you opportunities to learn and advance in a system of hospitals and clinics across Oregon and Southwest Washington. All are welcome.
OHSU welcomes people of all ages, ethnicities, genders, national origins, religions and sexual orientations. We are striving to build an anti-racist, multicultural institution and encourage people with diverse backgrounds to apply. To request reasonable accommodation, contact askhr@ohsu.edu
40 hours per week