Seeking candidates for a Explanation of Benefits EOB Reviewer career opportunity with our healthcare client in Santa Ana, CA.

SUMMARY

Under the direction of the Collections Supervisor/Manager, the EOB Reviewer will perform his/her duties in accordance with CBO guidelines.

REQUIREMENTS:
Demonstrates competency in the quality of work and knowledge of the job pertinent to the functioning of EOB Reviewer.

Ensure all discounts are applied to each account as specified in each contract.

Enter all correspondence/EOBs received into the computer.

Update patient demographics, including insurance company information and financial class changes.

Keep EOB review and interpretation current.

Transfer charges or insurance payments when appropriate.

Send accounts to audit as requested by patients or insurance companies.

Research information by phone for other departments within the hospital.

Send requests to Health Information Services for requested information, i.e. ER reports, operative reports, etc to designated Hospital. .

Update patient responsibility in (MU) Screen and send patient a CEBPL when applicable.

Request Manual Move to Pay and adjustments on accounts when applicable.

Request clinical appeals when applicable.

Submit Provider Disputes to insurances when applicable.

Verifies Mcare/Mcal/Calop eligibility when applicable.

Assist with special projects.

REQUIREMENTS:
Minimum of 2-5 years’ experience in hospital billing of an acute care facility or equivalent of other work experience.

High school diploma preferred.

Ability to type 40 words per minute.

Good oral communication skills are required to discuss payment adjudication with insurance companies.