Patient Billing and Collection Rep III - 141120

The mission of the Student Health & Well-Being (SHW) cluster is to promote a culture of health and well-being for the student community, deliver equitable high quality innovative services, incorporate inclusive approaches, and celebrate diversity, with the goal of adoption and maintenance of healthy behaviors contributing to the academic success and personal development of all students.

The UC San Diego SHW cluster, which reports through UC San Diego Health System, plays a leadership role in creating a strong and active wellness culture that enables all students to flourish in body, mind and spirit. This includes promotion and the transformation of existing departments, under the oversight of the Executive Director, into a cohesive, trans-disciplinary source of integrated wellness services. The SHW cluster includes the departments of Student Health Services (SHS); Health Promotion Services (HPS); Counseling and Psychological Services (CAPS); Assessment and Analytics (SHAA), Strategic Planning, Innovation and Research (SPIR); and SHW Administration (ADM). The SHW cluster provides health promotion, counseling and psychological services and primary medical care, including urgent care and support services, to all UC San Diego's undergraduate, graduate and professional students and UC affiliates. Staff consists of physicians, psychiatrists, psychologists, pharmacists, optometrists, nurse practitioners, registered nurses, social workers, radiology technologists, clinical laboratory scientists, medical lab assistants, medical assistants, health educators, data scientists, administrative, financial and other healthcare professionals.

SHW Administration provides full administrative, business, financial and infrastructure services, including support for the Executive Director's Office, resource planning, budget management, information systems, contracts management; human resource management, medical and health staff credentialing and privileging; medical records management, insurance management, patient billing and collections; facilities, equipment and space.

Administers the student health insurance program and other campus agreements. In collaboration with Insurance/Patient Billing and Collection Team, formulates strategies and administers policies, processes and resources. Acts as a Student Health Insurance Plan (SHIP) Liaison between students and the insurance plan administrators and various healthcare providers. Provides education to students on reconciling insurance statements and bills from external resources. Gathers and analyzes SHIP utilization and expenses based on a variety of sources, including the health plan, third party administrators and SHW.

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. Performs the full range of responsibilities within the patient billing and collections function.

Prepares and processes transactions for billing to insurance plans and students. Receives and processes insurance and student payments, monitors and reconciles outstanding charges, and submits charges for Bursar activity, as well as non-Bursar student charge tracking.

Provides assistance and support with special insurance, billing-related projects and implementations, and revenue cycle reviews. Understands and applies medical and insurance terminology.

• Seven (7) years of relevant experience or a Bachelor's degree in a related field plus three (3) years of experience.

• Strong knowledge of billing and / or collections processes, concepts, systems and external regulations. Knowledge of medical terminology and coding.

• Strong interpersonal and customer service skills to work effectively with all parties to the billing and collection process, and to productively negotiate terms for successful resolution of outstanding accounts and problems. Demonstrated skill to resolve conflict and handle confrontation with calm, tact and professionalism. Excellent verbal and written communication skills, with the ability to clearly communicate detailed and complicated information.

• 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. Knowledge of business software, specialized applications and EHR systems used in health centers / clinics. Demonstrated experience and competency with standard business equipment, computer technologies and a variety of software including system and networking software, Microsoft Office suite, email and a variety of web-based programs and browsers, with the willingness and ability to update and increase skills as needed to meet the goals of the unit and the division. Demonstrated experience in using electronic medical records and understanding of medical record management.

• Strong organizational skills, with ability to work effectively with frequent interruptions and in a high volume, complex and demanding customer service operation.

• Strong knowledge of the regulations and confidentiality issues involved in the revenue side of medical care, including private and government insurance, self-pay, collections, and reporting and data management. Ability to use discretion, maintain utmost confidentiality and comply with all requirements in use of computer systems and access to any and all patient, student, employee and University data, in electronic and hard copy formats, in compliance with University, state and federal guidelines, including, but not limited to Health Insurance Portability and Accountability Act (HIPAA) and Family Educational Rights and Privacy Act (FERPA).

• Strong analytical skills to produce comprehensive reports, and identify trends and variations. Ability to coordinate assignments, prioritize responsibilities and foster a professional, positive, team work environment.

• 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.

• Demonstrated ability to actively foster a positive, welcoming climate, and value, include and support all in the UC San Diego community.

• Strong ability to use good judgment, instincts and experience in working with student patients, parents, medical personnel and university officials at various levels and in times of emergency and stress.

• Ability to demonstrate the characteristics of professionalism in attire, attitude, conversation, behavior and attentiveness to others; uphold the UCSD Principles of Community and promote a positive and collaborative team environment.

• Demonstrated commitment and ability to acknowledge, advocate and support the efforts to dismantle structural racism and divisive biases based on race, ethnicity, sex, gender identity, age, disability, sexual orientation, religion, and political beliefs.

• Complete all required training assigned by UCOP, UCSD and SHW on a timely basis.

• As appropriate, submit incident reports into the UCSD SHW Incident Report System, RL Datix or current system in use, to report near-misses, process problems or patient or employee injury events. Attend required trainings and refreshers for use and proper steps to follow.

• Working knowledge of EPIC and ISIS student information systems. Training is provided and required upon hire for this position.

• Ability to administer policies and procedures under the UC Student Health Insurance Plan (SHIP), Reduced Access for Tritons (RAFT), Fee for Service and other insurance plans and contractual agreements.

• Occasionally required to work overtime, weekend or evening hours.

• Employment is subject to a criminal background check and pre-employment physical.