Finance Rep II
Cincinnati Children's Hospital Medical Center, San Jose, California, United States, 95199
JOB RESPONSIBILITIES
Own the Facility Billing Process (UB‑04)
Prepare, review, and submit hospital (UB‑04) claims for inpatient, outpatient, and procedural services.
Validate that charges, units, revenue codes, modifiers, and documentation are correct and complete before submission.
Scrub claims and correct edits related to coverage, coding, authorization, medical necessity, or clinical documentation.
Review rejections and resolve issues to ensure timely, compliant claim submission.
Manage Hospital Accounts Receivable With Precision
Conduct thorough follow‑up with third‑party payers on outstanding or denied hospital accounts.
Research payer rules and reimbursement methodologies (DRG, APC, per diem, carve-outs) and apply them to claim resolution.
Resolve inpatient and outpatient claim discrepancies quickly to reduce AR aging.
Process, post, and balance payments and adjustments accurately and in the correct period.
Support Charge Capture & Revenue Integrity
Coordinate closely with inpatient, outpatient, emergency, and procedural areas to validate accurate charge entry.
Identify missing, incorrect, or duplicate charges and collaborate with departments to correct them.
Assist with maintaining and updating the hospital charge master, ensuring rates, codes, and descriptions stay accurate and competitive.
Strengthen Billing Operations & Systems
Maintain and update billing templates, payer information, and physician/departmental billing requirements.
Ensure information flows correctly between charge systems, billing systems, and payer portals.
Support system updates and test new workflows that improve speed, accuracy, or compliance.
Collaborate Across Departments
Act as a liaison between Hospital Billing Operations and key departments such as Access Services, Admitting, Outpatient Surgery, Outpatient Departments, Payer Relations, Cash Applications, and Physician Billing Services.
Provide insight on payer requirements and help clinical teams understand how documentation impacts reimbursement.
Assist as a resource for new team members and serve as a subject matter expert for non‑routine billing situations.
Maintain the Highest Quality Standards
Produce and review quality assurance reports to ensure billing accuracy and compliance.
Support utilization review activities by coordinating with UR teams and payers as needed.
Uphold integrity and compliance across all billing actions, following hospital and regulatory guidelines.
Why This Role Matters
You help ensure Cincinnati Children’s receives accurate reimbursement — supporting the lifesaving care we provide every day. Your work:
Reduces financial stress for families
Supports operational excellence and compliance
Ensures clinical documentation is reflected correctly
Helps maintain the hospital’s financial strength and sustainability
You’re not just billing — you’re part of the care team.
JOB QUALIFICATIONS
High school diploma or equivalent
2+ years of work experience in a related job discipline
Primary Location
South Campus
Schedule
Full time
Shift
Day (United States of America)
Department
Hospital Billing Operations
Employee Status
Regular
FTE
1
Weekly Hours
40
*Expected Starting Pay Range
$18.16 - $22.25
About Us At Cincinnati Children’s, we come to work with one goal: to make children’s health better. We believe in a holistic team approach, both in caring for patients and their families, and in advancing science and discovery. We strive to do better and find energy and inspiration in our shared purpose. If you want to be the best you can be, you can do it at Cincinnati Children’s.
Cincinnati Children's is:
Recognized by U.S. News & World Report as a top 10 best Children’s Hospitals in the nation for more than 15 years
Consistently among the top 3 Children’s Hospitals for NIH Funding
Recognized as one of America’s Best Large Employers (2025) and America’s Best Employers for New Grads (2025)
One of the nation's America’s Most Innovative Companies as noted by Fortune
Consistently certified as a great place to work
A Leading Disability Employer as noted by the National Organization on Disability
Magnet® designated for the fourth consecutive time by the ANCC
We Embrace Innovation—Together. We believe in empowering our teams with the tools that help us work smarter and care better. That’s why we support the responsible use of artificial intelligence. By encouraging innovation, we’re creating space for new ideas, better outcomes, and a stronger future—for all of us.
Comprehensive job description provided upon request.
Cincinnati Children’s is proud to be an Equal Opportunity Employer committed to creating an environment of dignity and respect for all our employees, patients, and families. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, genetic information, national origin, sexual orientation, gender identity, disability or protected veteran status. EEO/Veteran/Disability
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Prepare, review, and submit hospital (UB‑04) claims for inpatient, outpatient, and procedural services.
Validate that charges, units, revenue codes, modifiers, and documentation are correct and complete before submission.
Scrub claims and correct edits related to coverage, coding, authorization, medical necessity, or clinical documentation.
Review rejections and resolve issues to ensure timely, compliant claim submission.
Manage Hospital Accounts Receivable With Precision
Conduct thorough follow‑up with third‑party payers on outstanding or denied hospital accounts.
Research payer rules and reimbursement methodologies (DRG, APC, per diem, carve-outs) and apply them to claim resolution.
Resolve inpatient and outpatient claim discrepancies quickly to reduce AR aging.
Process, post, and balance payments and adjustments accurately and in the correct period.
Support Charge Capture & Revenue Integrity
Coordinate closely with inpatient, outpatient, emergency, and procedural areas to validate accurate charge entry.
Identify missing, incorrect, or duplicate charges and collaborate with departments to correct them.
Assist with maintaining and updating the hospital charge master, ensuring rates, codes, and descriptions stay accurate and competitive.
Strengthen Billing Operations & Systems
Maintain and update billing templates, payer information, and physician/departmental billing requirements.
Ensure information flows correctly between charge systems, billing systems, and payer portals.
Support system updates and test new workflows that improve speed, accuracy, or compliance.
Collaborate Across Departments
Act as a liaison between Hospital Billing Operations and key departments such as Access Services, Admitting, Outpatient Surgery, Outpatient Departments, Payer Relations, Cash Applications, and Physician Billing Services.
Provide insight on payer requirements and help clinical teams understand how documentation impacts reimbursement.
Assist as a resource for new team members and serve as a subject matter expert for non‑routine billing situations.
Maintain the Highest Quality Standards
Produce and review quality assurance reports to ensure billing accuracy and compliance.
Support utilization review activities by coordinating with UR teams and payers as needed.
Uphold integrity and compliance across all billing actions, following hospital and regulatory guidelines.
Why This Role Matters
You help ensure Cincinnati Children’s receives accurate reimbursement — supporting the lifesaving care we provide every day. Your work:
Reduces financial stress for families
Supports operational excellence and compliance
Ensures clinical documentation is reflected correctly
Helps maintain the hospital’s financial strength and sustainability
You’re not just billing — you’re part of the care team.
JOB QUALIFICATIONS
High school diploma or equivalent
2+ years of work experience in a related job discipline
Primary Location
South Campus
Schedule
Full time
Shift
Day (United States of America)
Department
Hospital Billing Operations
Employee Status
Regular
FTE
1
Weekly Hours
40
*Expected Starting Pay Range
$18.16 - $22.25
About Us At Cincinnati Children’s, we come to work with one goal: to make children’s health better. We believe in a holistic team approach, both in caring for patients and their families, and in advancing science and discovery. We strive to do better and find energy and inspiration in our shared purpose. If you want to be the best you can be, you can do it at Cincinnati Children’s.
Cincinnati Children's is:
Recognized by U.S. News & World Report as a top 10 best Children’s Hospitals in the nation for more than 15 years
Consistently among the top 3 Children’s Hospitals for NIH Funding
Recognized as one of America’s Best Large Employers (2025) and America’s Best Employers for New Grads (2025)
One of the nation's America’s Most Innovative Companies as noted by Fortune
Consistently certified as a great place to work
A Leading Disability Employer as noted by the National Organization on Disability
Magnet® designated for the fourth consecutive time by the ANCC
We Embrace Innovation—Together. We believe in empowering our teams with the tools that help us work smarter and care better. That’s why we support the responsible use of artificial intelligence. By encouraging innovation, we’re creating space for new ideas, better outcomes, and a stronger future—for all of us.
Comprehensive job description provided upon request.
Cincinnati Children’s is proud to be an Equal Opportunity Employer committed to creating an environment of dignity and respect for all our employees, patients, and families. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, genetic information, national origin, sexual orientation, gender identity, disability or protected veteran status. EEO/Veteran/Disability
#J-18808-Ljbffr