Medi-Cal/Medicaid Patient Account Representative

Essential Duties And Responsibilities

• Responsible for submitting accurate claims, ensuring timely reimbursement from various third-party payers and patients, and confirming proper documentation occurs in the facilities’ billing system.
• Collaborates with Revenue Cycle departments and third-party payers on efforts related to follow-up, denials, and appeals.
• Is Responsible for all Medi-cal/Medicaid and Managed Medicaid plan billing and follow up.
• Examines denied and underpaid claims to determine reasons for discrepancies.
• Communicates via phone calls and web-portals, directly with payers to follow up on outstanding claims, resolves payment variances, and achieves timely reimbursement.
• Provides payers with specific reasons for suspected underpayments and reviews denial reasons given by payers.
• Drafts patient account (HAR) with status and expected payment amounts.
• Works with management to identify, trend, and address root causes of denials; helps pinpoint strategies for reducing Accounts Receivables (A/R).
• Maintains a thorough understanding of federal and state regulations, as well as specific payer requirements and explanations of benefits, in order to identify and report billing compliance issues and payer discrepancies.
• Keeps current using payer bulletins, coding and billing training and manuals.
• Updates and maintains accurate files on each payer, including contact names, addresses, phone numbers, and other pertinent information.
• Notifies PFS Management of changes to update other TFH Departments.
• Thoroughly documents all interactions with payers.
• Handles all payer-specific communications, including telephone and email, from payers and departments within the business office.
• Participates in quality improvement efforts on an ongoing basis.
• Strives to exceed productivity goals as established based on industry standards as approved quarterly by the CFO.
• Demonstrates initiative and resourcefulness by gathering information and examples about issues and helping to document recommendations for system fixes.
• Communicates trends and issues to management and helps to monitor and validate fixes.
• Understands and maintains compliance with HIPAA guidelines when handling patient information.
• Performs other duties as assigned.
• Demonstrates System Values in performance and behavior.
• Complies with System policies and procedures.

Qualifications

• No educational requirement and 2-3 years relevant experience.
• Minimum of two years recent billing and follow-up experience in hospital and/or physician clinical areas.
• Prior Experience with billing Medi-cal and Medi-cal Managed Care is preferred.
• Prior experience in EPIC Hospital Billing and/or Physician Billing is preferred.
• Prior experience billing NV Medicaid and Managed Medicaid is preferred.
• Knowledge in Critical Access and RHC billing is preferred.