Patient Assistance Specialist - Outpatient - 138961

The Patient Assistance Specialist is responsible for the full range of third party and patient billing duties. Extensive knowledge of medical insurance and State and Federal rules and regulations related to billing Insurance Claims. Knowledge in self-pay collections and mandated charity laws. Knowledge of medical/surgical terminology. Knowledge of accounting and cash handling principles and various billing documents and claim forms. Responsible to work system generated claims, edits, attaches records, operative reports and all system reports. Responds to billing inquiries from patients, insurance companies and departments. Identifies and resolves issues regarding account adjustments, rebilling insurance, and/or collecting from patients as appropriate. Job is to be performed at the EXPERT level. Other related duties as assigned.

• Three (3) years of medical and pharmacy claims billing, denial mitigation and appeals.

• Familiar with reading medical and pharmacy records in order to submit records to support medical necessity based on diagnosis and services rendered.

• Clear understanding or know how to properly obtain the different types of payer information timely and how to prioritize workload based on the payer specific info.

• Capable and comfortable with verifying patient coverage/insurance verification and adjudication via a payer portal, Epic system or by phone.

• Extensive knowledge of pharmacy and medical insurance billing/processes, billing documents, claim forms, HIPAA, PHI, and a thorough understanding of state and federal rules for billing and appealing pharmacy and medical claims.

• Knowledge of eligibility criteria of pharmaceutical companies and foundations.

• Strong proficiency with MS Office Products (Mail, Excel and Word).

• Detail oriented, with organizational skills and the ability to manage time efficiently, prioritize tasks, and complete assignments consistently on schedule.

• Basic communications skills, with the ability to interpret and present clinical financial information clearly and concisely.

• Experience in Social Determinants of Health to advocate for patients with special needs.

• Pharmacy Financial Assistance experience.

• Outpatient Pharmacy general experience.

• Must be able to work various hours and locations based on business needs.

• Employment is subject to a criminal background check and pre-employment physical.

If employed by the University of California, you will be required to comply with our Policy on Vaccination Programs, which may be amended or revised from time to time. Federal, state, or local public health directives may impose additional requirements.

If applicable, life-support certifications (BLS, NRP, ACLS, etc.) must include hands-on practice and in-person skills assessment; online-only certification is not acceptable.

UC San Diego Health is the only academic health system in the San Diego region, providing leading-edge care in patient care, biomedical research, education, and community service. Our facilities include two university hospitals, a National Cancer Institute-designated Comprehensive Cancer Center, Shiley Eye Institute, Sulpizio Cardiovascular Center, the only Burn Center in the county, and dozens of outpatient clinics. We invite you to join our team!

Applications/Resumes are accepted for current job openings only. For full consideration on any job, applications must be received prior to the initial closing date. If a job has an extended deadline, applications/resumes will be considered during the extension period; however, a job may be filled before the extended date is reached.

To foster the best possible working and learning environment, UC San Diego strives to cultivate a rich and diverse environment, inclusive and supportive of all students, faculty, staff and visitors. For more information, please visit UC San Diego Principles of Community.

The University of California is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected status under state or federal law.

For the University of California's Anti-Discrimination Policy, please visit: https://policy.ucop.edu/doc/1001004/Anti-Discrimination

UC San Diego is a smoke and tobacco free environment. Please visit smokefree.ucsd.edu for more information.

UC San Diego Health maintains a marijuana and drug free environment. Employees may be subject to drug screening.

Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts an offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; or have filed an appeal of a finding of substantiated misconduct with a previous employer.

a. "Misconduct" means any violation of the policies governing employee conduct at the applicant's previous place of employment, including, but not limited to, violations of policies prohibiting sexual harassment, sexual assault, or other forms of harassment, or discrimination, as defined by the employer. For reference, below are UC's policies addressing some forms of misconduct:

• UC Sexual Violence and Sexual Harassment Policy
• UC Anti-Discrimination Policy
• Abusive Conduct in the Workplace