About The Wilshire Group
The Wilshire Group, a renowned boutique consulting firm in Los Angeles, specializes in revenue cycle optimization and fostering effective collaboration between operational and IT facets. With a robust track record of aiding over 100 healthcare systems nationwide, our team thrives on professionalism, efficiency, and adaptability.
Our core values- professionalism, efficiency, and flexibility- underscore our commitment to creating an inclusive and dynamic workplace. We embrace diverse narratives and believe in offering opportunities to exceptional individuals who bring their best to the table.
We are currently offering a contracted interim position at one of US News Best Hospitals 2022-23. This position caters to top performers seeking a professional environment that acknowledges and values their dedication and proficiency. While this role doesn’t offer benefits, it presents an opportunity to work within an organization that encourages talented individuals to surpass conventional boundaries.
Join us at The Wilshire Group, a place where talented professionals find a home to showcase their skills and contribute meaningfully to the healthcare landscape.
Why Wilshire? Employee Testimonial
“The number of RCM subject matter experts I get to work with each day is unreal. Working alongside and as part of this team to help shape the RCM space is exciting.”-Patti Consolver, Director of Business Development
Work Location: Remote_CA-Remote-CA
Job Title: Revenue Cycle - Customer Resolution Specialist
Job Description:
Responsible for performing customer care activities in accordance with applicable Federal, State, and local standards, guidelines, and regulations. These responsibilities include, but are not limited to, customer service, billing, and/or patient account balance collection activities associated with the hospital and professional revenue cycle.
What you will do:
- Performs or requests adjustments and contractual write-offs as applicable
- Maintains a thorough understanding of hospital and professional billing procedures and payment practices of state, federal and all third-party payers.
- Resolves HB and PB customer service inquiries, which could include: Benefit and eligibility information, Billing and payment issues, Authorization for treatment, Explanation of benefits (EOB)
- Perform timely and efficient collection of all HB and PB self-pay balances by calling patients/guarantors and others to collect or arrange budget plan options and resolve issues.
- Performs presumptive charity determinations as applicable.
- Performs bad debt request transfers as applicable.
- Ensures daily productivity standards of assigned accounts are met and posting of all action codes related to patients’ accounts
- Maintains a thorough, practical understanding of departmental established policies and procedures
- Other duties as assigned
Education Qualifications:
- High School diploma or GED equivalent
Experience Qualifications:
- 3 years of progressively responsible and directly related work experience
Required Knowledge, Skills and Abilities:
- Government/non-government payer requirements, reimbursement rules, laws and regulations that govern billing/collection activities
- Medical terminology, CPT-4, ICD-9, HCPCS, modifier coding and how these items drive reimbursement
- Principles and practices of customer service and telephone courtesy
- Organizational, planning, analytical and problem solving skills
- Attention to detail and follow-through
- Demonstrated verbal and written communication skills
- Microsoft Office applications (Word and Excel)
- Epic Professional Billing preferred
Licenses and Certifications:
- HFMA - Certified Rev Cycle Rep (CRCR) preferred
