Looking for a strong Billing/Claims Specialist to join our team!
This role is a 6 month contract to hire (based off performance/attendance)
About this role:
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no research experience
- strong billing experience
- coding experience (don't need to be a coder)
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inpatient hospital claims (UB-04 form)
- EPIC (nice to have)
- 1st 3-4 weeks: 3x a week onsite then moving forward (hybrid) 1 day onsite and 4 days remote
Pay Range: $23/hr - $25/hr (based off years of experience)
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Epic Queue Management: Review, manage, and clear daily billing work queues within the Epic system to ensure steady cash flow and minimal claim delays.
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Inpatient Claims Review: Conduct detailed reviews of inpatient hospital claims utilizing UB-04 forms, ensuring all clinical data matches documentation.
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Bundle Services Analysis: Evaluate complex clinical charts (specifically focusing on high-level specialties like Cardiology and Oncology) to identify bundled services and determine exactly which billing codes must be pulled or separated.
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Claim Scrubbing & Compliance: Audit claims against current CMS rules, guidelines, and localized billing regulations to prevent denials before submission.
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Coverage Analysis Reconciliation: Review patient charts against established clinical trial coverage analyses to determine which procedures are billable to the patient's insurance versus what must be billed to the research study sponsor.
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CTMS Maintenance: Utilize the Clinical Trial Management System (CTMS) daily to log, track, and reconcile research-related patient encounters and billing paths.
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Research vs. Standard of Care Auditing: Double-check routine hospital bills for clinical trial participants to ensure research-sponsored procedures were not mistakenly billed to public or private insurance.
For California Applicants:
We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).
This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.
