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EOB Reviewer in Santa Fe Springs, CA at Avanti Hospitals

Date Posted: 2/12/2019

Job Snapshot

Job Description

Central Business Office

Job Title: EOB Reviewer 

City: Santa Fe Springs / State: California    

Patient Accounting

Day Shift

From 8:00 AM

To 4:30 PM

                                      


Job Description and Job Responsibilites

Job Title:  EOB Reviewer

Job Summary: 

To review EOB’s (Explanation of Benefits) for correct reimbursement. Must document, and identify underpayments and process adjustments in an accurately, and timely manner.  To ensure financial classes and or I/Plans are changed to the appropriate payor. Reports to Managed Care Manager and or Terms and Condition Manager

Essential Job Duties: 

  • Demonstrates competency and complete understanding of Managed Care insurance billing, collections and contracts.

  • Responsible to review EOB’s for correct reimbursement, documents under payments and prepares contractual adjustments.

  • Maintains Contracts with appropriate reimbursement information as well as correct payor codes.

  • Reviews all Managed Care Capped accounts prior to contractual write off.

  • Works effectively with Hospital Contracts Management to resolve contract issues.

  • Monitors contracts and Explanation of Benefits to ensure proper calculation and payment processing.

  • Demonstrates competency when reviewing E.O.B’s for managed care medi-cal HMO’s according to Medi-cal state HCPCS codes and fee schedule reimbursement.

  • Knowledge in billing claims thru E-Premis/Relay Clearance systems.

  • Responsible to reclassify Managed Care accounts as per EOB’s received.

  • Performs all other duties and special projects as assigned in an organized and timely manner.

Behavioral Standards: 

  • Exhibits customer and service oriented behaviors in every day work interactions.

  • Demonstrates a courteous and respectful attitude to internal workforce and external customers.

  • Communicates accurately and appropriately.

  • Works well and efficiently under minimal supervision.

  • Handles difficult situations in a discreet and professional manner.

  • Demonstrates a willingness to act as a representative of the hospital.

  • Maintains a good attendance record.

  • Adheres to timekeeping procedures at all times.

  • Is adaptable to changes in assignments and priorities.

Communication/Knowledge:

  • Provides accurate and timely written and verbal communication of information in a manner that is understood by all.   

  • Able to listen, understand, problem-solve, and carry-out duties to ensure the optimal outcome.

  • Able to use IT systems in an accurate and proficient manner.

Collaboration/Teamwork:

  • Contributes toward effective, positive working relationships with internal and external colleagues.

  • Demonstrates cooperation, flexibility, reliability, and dependability in all daily work activities and a willingness to collaborate with others for the good of the customer and the organization.




Job Requirements

Education/Experience:

  • High school graduate or equivalent required

  • Prefer at least 2 to 3 years of current experience in an acute care hospital setting

  • Excel knowledge a must

Licensure/Certifications:  N/A

ADA/Physical Demands:

  • To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed are representative of the knowledge, skill, and/or ability required.  Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Such accommodations must be requested by the employee/applicant in order to be considered.

  • Required to stand; walk; sit; use hands to fingers, handle, or feel; reach with hands and arms; stoop, kneel, crouch, or crawl; talk and hear; and may taste and smell.  The employee is regularly required to lift, push and/or pull weights in excess of 10 pounds, with assistance. Visual abilities, auditory abilities, must be intact to perform duties.

 

Job Requirements

Education/Experience:

  • High school graduate or equivalent required

  • Prefer at least 2 to 3 years of current experience in an acute care hospital setting

  • Excel knowledge a must

Licensure/Certifications:  N/A

ADA/Physical Demands:

  • To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed are representative of the knowledge, skill, and/or ability required.  Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Such accommodations must be requested by the employee/applicant in order to be considered.

  • Required to stand; walk; sit; use hands to fingers, handle, or feel; reach with hands and arms; stoop, kneel, crouch, or crawl; talk and hear; and may taste and smell.  The employee is regularly required to lift, push and/or pull weights in excess of 10 pounds, with assistance. Visual abilities, auditory abilities, must be intact to perform duties.