Follow-up Representative

Ampcus Inc. is a certified global provider of a broad range of Technology and Business consulting services. We are in search of a highly motivated candidate to join our talented Team.

Job Title: Follow-up Representative

Location(s): Emeryville, CA

(Hybrid: onsite at least 3 days/week for training, then onsite once a month).

• Epic Resolute Professional Billing experience (required).
• Experience in medical billing, with a preference for Professional Fee (ProFee) billing (required).
• Insurance claims follow-up experience/ Denial management experience (preferred).
• Familiarity with payer websites and payer provider services (required).
• Experience with Government Professional Fee (ProFee) billing.
• Knowledge of Medi-Cal managed care processes (preferred).

• Examines and evaluates accounts for appropriate follow-up action consistent with guidelines and documentation protocols prescribed in the SRG (Situation Response Guide).
• Make daily inquiries on unresolved invoices by phone or via the internet.
• Interpret account information and enter important details to provide an audit trail for further follow up.
• Research missing payments by reviewing EOB (Explanation of Benefits), APEX and RMS.
• Review of non-payment and/or incorrect payment for possible appeal. This may include, but is not limited to the use of the following reference tools and guidelines:
  
  
  
  • CCI edits
  • UCSF Contract Report
  • Profee Grid
  • Medicare Fee Schedule
  • Cascading guidelines
  • CPT, ICD-10, HCPC, Medical Terminology Manuals.
  
  
  
  
• Analyze Explanation of Benefits (EOBs) for accurate posting of rejection, adjustment and other posting requirements needed in APEX.
• Adheres to the rules and regulations of the different types of payers such as Medicare, Medi-Cal, CCS, PPO, EPO, HMO, and commercial insurance.
• Initiate Charge Correction request.
• Submit requests to department via RFI (Request for Information) process and review response for appropriate action.
• Retrieve all required information needed in order to evaluate correct credit balance and/or correct refund payee.
• Complete and submit refund request with detailed back-up to the unit manager for approval.
• Effectively communicate with MGBS peers, payers, patients, UCSF departments Leads, Assistant Managers and managers. .
• Utilize knowledge of various systems including, but not limited to:
  
  
  
  • Microsoft Word, EXCEL, Outlook, APEX, Payor Web Portals, Health Logic, government and/or non-government websites, and any other information systems which would be required for insurance eligibility, benefit verification or other information needed during detailed follow-up.
  
  
  
  
• Other Follow Up Duties May include:
  
  
  
  • Secure guarantor/patient demographic and /or insurance information as required.
  • Process correspondence as required in accordance with departmental procedures.
  • Billing or rebilling corrected claims.
  • Create Orthopedic DME (Durable Medical Equipment) Invoice form for DME billing attachment.
  
  
  
  
• Notify manager of possible procedural change for improving efficiency.
• Perform other duties as assigned.
• Perform Special Projects or Other Duties as Assigned by the Assistant Manager or Manager.
• Attend and be engaged in monthly CQI and KPI (monthly one on one) meeting and unit and team meetings aimed at increasing knowledge.

• Demonstrates service excellence by following the Everyday PRIDE Guide with the UCSF Medical Center standards and expectations for communication and behavior. These standards and expectations convey specific behavior associated with the Medical Center's values: Professionalism, Respect, Integrity, Diversity and Excellence, and provide guidance on how we communicate with patients, visitors, faculty, staff, and students, virtually everyone, every day and with every encounter. These standards include, but are not limited to: personal appearance, acknowledging and greeting all patients and families, introductions using AIDET, managing up, service recovery, managing delays and expectations, phone standards, electronic communication, team work, cultural sensitivity and competency.
• Uses effective communication skills with patients and staff; demonstrates proper telephone techniques and etiquette; acts as an escort to any patient or family member needing directions; shows sensitivity to differences of culture; demonstrates a positive and supportive manner in which patients / families/ colleagues perceive interactions as positive and supportive. Exhibits team work skills to positively acknowledge and recognize other colleagues, and uses personal experiences to model and teach Living PRIDE standards.
• Exhibits tact and professionalism in difficult situations according to PRIDE Values and Practices.
• Demonstrates an understanding of and adheres to privacy, confidentiality, and security policies and procedures related to Protected Health Information (PHI) or other sensitive and personal information.
• Demonstrates an understanding of and adheres to safety and infection control policies and procedures.
• Assumes accountability for improving quality metrics associated with department/unit and meeting organizational/departmental targets.

• Keeps working areas neat, orderly and clutter-free, including the hallways. Adheres to cleaning processes and puts things back where they belong. Removes and reports broken equipment and furniture.
• Picks up and disposes of any litter found throughout entire facility.
• Posts flyers and posters in designated areas only; does not post on walls, doors or windows.
• Knows where the Environment of Care Manual is kept in department; corrects or reports unsafe conditions to the appropriate departments.
• Protects the physical environment and equipment from damage and theft.

• This position requires flexibility to orient and work at all UCSF Medical Center locations.
• At least 1 year of previous Insurance Follow up experience.
• Demonstrate the Ability to communicate effectively (orally and written).
• Knowledge of CPT and ICD-10.
• Experience With Denials Management.
• Experience with MS EXCEL and OUTLOOK.
• Effective Time Management and Ability to Meet Deadlines.
• Ability to work independently or as needed with a team.
• Ability to meet productivity and quality standards.
• Demonstrates positive attitude and excellent customer service skills.
• Proven ability to coach and mentor staff for optimal results.
• Ability to set priorities, goals and objectives.
• Demonstrate the ability to perform all aspects of billing and follow-up with superior quality.
• Excellent Attendance Record.

• Prior working knowledge of the EPIC (Apex) system, especially PB or HB Insurance Follow up Module(s).
• Certified Procedural Coder (CPC).
• High School Graduate or GED equivalency.
• Associates or Bachelor's Degree.

Ampcus is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identify, national origin, age, protected veterans or individuals with disabilities.