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Job DetailsJob Location: Harter Building - Yuba City, CA 95993Position Type: Full TimeSalary Range: $29.81 - $40.24 HourlyGENERAL PURPOSE: Patient Account Services Representative is responsible for the revenue cycle management of a claim for all payer sources. This includes reviewing claims prior to billing based on established system edits. After initial billing it includes, monitoring, correcting and re-billing claims for Medicare, Medi-Cal, Managed Care, Private Insurances, CHDP, Family Planning, EWC, Private Pay, and Sliding Fee patients until the balance of the claim is zero. MAIN RESPONSIBILITIES AND DUTIES: Review claims prior to billing that requires manual intervention, based on specific criteria for that payer source to include Medi-Cal, Managed Care, Medicare, CHDP, Family Planning, EWC, special programs, private insurances, sliding fee and self-pay. Keep current on payer claims processing manuals, updates and reference material and portals for each payer source to ensure correct follow-up. Print all necessary billing forms, including secondary claims, attaching EOB’s for any payer who does not accept electronic secondaries. Check the patient’s eligibility when reviewing pre-billing for established edits and for claims denied due to eligibility, correct and re-submit claim(s). This includes insurance changes to financial class sent by the clinic staff, where correction to account and resubmission of claims is necessary. Enter hospital charges into the system. Access the hospital system to ensure correct insurance is being billed. Ensure all hospital charge slips have the proper CPT and ICD10 codes. For all other claim types, update CPT codes and ICD10 as appropriate. Verify correct PPS rate is received from Medicare and Medi-Cal. Verify correct payment is received for all other insurance types. If payment received is the same as the charge amount, notify Supervisor so charge can be adjusted if necessary. Follow procedures as outlined by the Supervisor/Manager to ensure correct claims processing for each payer source. This includes the follow-up on Explanation of Benefits (EOB’s) and Remittance Advice (RAD’s) from insurance companies where either no payment or only partial payment is received. Write up charge adjustment form as necessary and assist the Supervisor/Manager with new procedures for special programs. Meet productivity goals established by Supervisor/Manager. Resolve complex billing issues. Inform Supervisor/Manager of any system problem or payer problem that prevents you from collecting the amount due for claims. Monitor private pay accounts. Follow established procedures to include setting up payment plans. After final attempt to collect, adjust as bad debt. Post insurance and/or private pay payments received. Answer patient informational requests (both in person and via telephone). Open mail, distribute as appropriate, prepare log sheet of checks and prepare daily deposit. Other duties as assigned by supervisor. QUALITIES &CHARACTERISTICS Maintains a professional relationship and positive attitude with co-workers, the public, patients and all Ampla Health Maintains the highest professional ethics and is honest in dealing with people; is a model for all employees through his/her actions Strives to learn more and is receptive to learning different ways of doing things Displays enthusiasm toward the work and the missions of Ampla Health PROFESSIONAL KNOWLEDGE, SKILLS & ABLITIES Must have high school diploma or equivalent Ability to use Microsoft Word for basic correspondence Ability to type a minimum of 40 WPM Minimum of two years prior insurance billing experience, with knowledge of CPT Codes and ICD 10 Codes Knowledge of hospital and dental billing Knowledge of primary health care concepts Ability to adapt to specific environment and duties COMMUNICATIONS SKILLS Must have neat and legible handwriting Must be able to interact with patients courteously and calmly Ability to communicate well with the public WORKING CONDITIONS AND PHYSICAL REQUIREMENTS Works will with patients in a generally comfortable environment office. Employees must possess the following physical requirements: Must be able to hear and communicate with clients and staff on telephone and those who are served “in person”, and speak clearly in order to communicate information to clients and staff Must be able to lift up to 40 pounds and push up to 100 pounds (on wheel) Must have vision which is adequate to read memo’s, computer screen, registration forms and other clinic documents Must have high manual dexterity Able to reach above shoulder level to work, must be able to bend, squat and sit, stand, stoop, crouch, reach, kneel, twist/turn May be exposed to contagious/infectious diseases QualificationsPROFESSIONAL KNOWLEDGE, SKILLS & ABLITIES Must have high school diploma or equivalent Ability to use Microsoft Word for basic correspondence Ability to type a minimum of 40 WPM Minimum of two years prior insurance billing experience, with knowledge of CPT Codes and ICD 10 Codes Knowledge of hospital and dental billing Knowledge of primary health care concepts Ability to adapt to specific environment and duties COMMUNICATIONS SKILLS Must have neat and legible handwriting Must be able to interact with patients courteously and calmly Ability to communicate well with the public
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