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Commercial Government Specialist - Business Office - Full Time/Days in Lancaster, CA at Antelope Valley Hospital

Date Posted: 12/9/2018

Job Snapshot

Job Description

Job Objective:

 Under the direction of the Billing Supervisor or designee, ensures all accounts are accurately reviewed, billed, and followed up timely, ensuring that the hospital's accounts receivable is as accurate as possible

Duties and Responsibilities:

 A. Commercial, Government or State Billing, as assigned

  1. Validate and/or make corrections on the UB04 for accuracy of billing information
  2. Review claims before submission for missing charges and/or implants
  3. Validates claims against the coding abstract to ensure accurate billing of procedures
  4. Work billing edit reports daily, correcting discrepancies before claim submission
  5. Split inpatient claims as appropriate, per carrier guidelines
  6. Submit claims to carriers with the appropriate attachments
  7. Run insurance eligibility as needed

    B. Insurance Follow-up on Government Plans and as assigned

  1. Contact insurance carriers regarding outstanding balances until resolution on government plans
  2. Resubmit bills to insurance carriers as needed
  3. File insurance carrier appeals for payment and/or denial disputes
  4. Validate accounts for accurate payments, discounts, and contractual adjustments
  5. Reply to insurance carrier correspondence as appropriate
  6. Answer in-coming calls, resolving patient, insurance, and/or vendor issues timely

    C. Medi-Cal Treatment Authorization Request (TAR) Processing, as assigned

  1. Monitors Medi-Cal TAR or CCS SAR to completion to ensure timely billing

    D. Credit Balance Processing

  1. Monitor credit balance report for in appropriate postings of contractual adjustments
  2. Resolve credit balances timely and efficiently
  3. Request refund checks and Medi-Cal CIFs, as needed

Non-Essential Duties:

  • Make appropriate contractual adjustments and/or recommendations
  • Assist in the daily download of electronic claims
  • Assists in the daily transmit of all electronic claims to the billing clearinghouse
  • Assist Operation Auditors as needed
  • Assist with other duties as assigned, within skill sets and abilities


Knowledge, Skills and Abilities:


  • Working knowledge of commercial plans, traditional and/or Managed Care government health plans.
  • Working knowledge of Managed Care contract language and interpretation, as needed
  • Working knowledge of Common Procedural Terminology (CPT) and ICD9/ICD10 Codes
  • Working knowledge of Federal, State, Commercial, and County billing guidelines
  • Working knowledge of Microsoft Office
  • Knowledge of basic arithmetic
  • Knowledge of basic personal computers
  • Knowledge of the use of calculators


  • Proficient in the operation of scanners, copiers, and fax machines


  • Ability to handle stress
  • Ability to manage a heavy caseload in an organized and efficient manner
  • Ability to complete appropriate account adjustment and write-offs
  • Ability to recognize potential accounts receivable related problems and offer solutions to management
  • Ability to maintain a working relationship with other departments within the organization
  • Ability to review all billing transactions for accuracy, discrepancies, and appropriate charges
  • Ability to document account information at time of account follow-up
  • Ability to run accounts receivable reports as needed


AVH Values: All AVH employees will effectively demonstrate these values:

  • Patients Come First – We listen actively and communicate with our patients and families, placing safety as a top priority.
  • Accountability & Ownership – We fully complete tasks, are transparent, effectively communicate, and recognize that what we do reflects on us.
  • Teamwork – We build trusting relationships, promote a sense of community, and are respectful of everyone.  Success is about the whole team.
  • Integrity & Honesty – We tell the truth at all times, speak up when something is wrong, and do the right thing when no one is looking.
  • Excellence – We take pride in our work, are goal-oriented, and on a never-ending quest for top tier quality.
  • Initiative & Innovation – Our can-do attitudes, creativity, and resourcefulness empower us to improve the patient’s experience, solve our own problems, make timely decisions, and look for opportunities to add value.
  • Tenderness & Compassion – We have genuine empathy, show kindness, and encourage and advocate for each other.

Education and Experience:


  • High School graduate or equivalent


  • Two (2) years State, Government, or Commercial billing experience
  • Working knowledge of Managed Care contract language and interpretation

Required Licensure and/or Certifications:

  • None

AVH Conduct/Compliance Expectations:

  • Ability to adhere with AVH Absenteeism and Tardiness Policy 
  • Ability to adhere with AVH Leaves of Absence Policy
  • Ability to adhere with AVH Paid Time Off (PTO) Policy
  • Ability to adhere with AVH Recording of Hours Worked Policy
  • Ability to adhere to the department dress code
  • Ability to organize work and establish priorities
  • Ability to expand on own initiative in performance of duties
  • Skill and ability to follow the telephone etiquette/standards
  • Conforms to AVH Standards of Excellence
  • Ability to function effectively under pressure and meet time parameters
  • Ability to communicate effectively while maintaining good working relationships with co-workers, managers and other hospital staff
  • Ability to adhere to the normal standards of courtesy and conduct as defined under the rules of hospitality at AVH
  • Ability to maintain the confidentiality of patient, hospital and department information
  • Ability to adhere to safety rules and regulations
  • Safely and effectively uses all equipment necessary to carry out duties
  • Ability to interpret and function under hospital and department policies and procedu

    Looking for an opportunity to work in healthcare the way you always dreamed you could? At Antelope Valley Hospital, our employees are at the heart of what we do best – delivering high quality, patient-centered healthcare.

    Antelope Valley Hospital, a 420 bed acute care facility, located just 60 miles north of Los Angeles, the Antelope Valley is one of Southern California’s fastest growing communities. We are a Level II Trauma Center and Joint Commission Primary Stroke Center Accredited. Serving the community for over 50 years, our non-profit hospital has grown to be the preeminent healthcare facility for our district’s nearly 1.2 million residents. 

    An Equal Opportunity Employer.


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