Transplant Billing & Follow Up Rep - Hybrid - 136611

UC San Diego Health is seeking a skilled and motivated Billing & Collections Representative to join our large-scale hospital billing operations team. This role focuses on Solid Organ Transplant, Bone Marrow Transplant (BMT), and CAR T billing and follow-up, one of the most specialized and complex areas of hospital revenue cycle. The successful candidate will demonstrate strong billing and collections expertise, attention to detail, and the ability to work claims from start to finish across government and commercial payors.

Key Responsibilities:

• Process Hospital Billing (HB) and Professional Billing (PB) claims for Solid Organ, BMT, and CAR T services across pre-, intra-, and post-transplant phases.
• Prepare and submit clean claims with all required documentation, ensuring accurate account linking and transplant bundle billing.
• Conduct account follow-up and collections: monitor outstanding balances, resolve denials, submit appeals, and escalate unresolved claims as needed.
• Review account trial balances (ATBs), hospital account records (HARs), and authorizations in Epic to ensure billing compliance.
• Collaborate with internal teams including Authorization, Financial Coordinators, and Revenue Integrity to resolve issues and secure payment.
• Maintain compliance with payer rules, state/federal regulations, and UC San Diego Health policies.

Key Skills:

• Billing & Collections Expertise: End-to-end claims management and denial resolution.
• Technical Proficiency: Epic HB/PB billing and transplant account structures.
• Analytical Ability: Review accounts, identify errors, and correct billing issues proactively.
• Collaboration: Partner with financial coordinators, clinicians, and payer representatives.
• Professional Communication: Confidently handle payer interactions and escalations.

• Three (3) years of recent acute care hospital billing and collection experience.

• Knowledge of medical insurance and State and Federal rules and regulations related to billing Insurance Claims.

• Extensive knowledge in Insurance claims appeals, and range of knowledge in ICD-10, CPT, HCPCS coding principles.

• Knowledge in self-pay collections.

• Knowledge of UB04 and revenue codes as it pertains to billing.

• Certification in billing/coding (e.g., CPC, CPB, HB).

• Strong working knowledge of Epic billing systems (HAR, ATB, Auth/Cert).

• Experience with government and commercial payors.

• Proven ability to resolve complex denials and secure payments on high-dollar accounts.

• Prior transplant billing experience (Solid Organ, BMT, CAR T) in an academic medical center or large hospital system.

• Knowledge of transplant billing phases:

  • Pre-Transplant: evaluation, testing, clearance, and how services are reimbursed or bundled.
  • Inpatient/Transplant Event: identifying anastomosis date, global case period start, and submitting bundle claims with required payer documentation.
  • Post-Transplant: billing re-admissions, outpatient follow-up, labs, and bundled care per payer agreement.

• Experience managing single-bundle and two-part bundle claims

• Familiarity with payer transplant networks and agreements across government and commercial payors

• Ability to review and prepare Billing Summaries, Itemized Statements, Organ Acquisition and Perfusion Invoices, and ensure proper inclusion/exclusion of services.

• Experience collaborating with Transplant Financial Coordinators (TFCs), Central Authorization Teams (CATs), and clinical staff to align financial clearance, authorizations, and claim submissions.

• Strong understanding of Epic billing functionality related to transplant (HAR, ATB, Auth/Cert, EOC linking).

• Demonstrated success in appeals and follow-up for high-dollar, complex transplant claims.

• 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.