Medi-Cal/Medicaid Patient Account Representative

Tahoe Forest Health System•Truckee, CA

5d•Hybrid

About The Position

This position is 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. The role collaborates with Revenue Cycle departments and third-party payers on efforts related to follow-up, denials, and appeals. The position requires a thorough understanding of federal and state regulations, as well as specific payer requirements and explanations of benefits, to identify and report billing compliance issues and payer discrepancies. The representative must maintain accurate files on each payer and thoroughly document all interactions. This role also involves participating in quality improvement efforts, striving to exceed productivity goals, and demonstrating initiative in gathering information and recommending system fixes. Compliance with HIPAA guidelines is essential when handling patient information.

Requirements

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.
Ability to perform each essential duty satisfactorily.
Ability to make reasonable accommodations for individuals with disabilities to perform essential functions.

Nice To Haves

Prior experience in EPIC Hospital Billing and/or Physician Billing.
Prior experience billing NV Medicaid and Managed Medicaid.
Knowledge in Critical Access and RHC billing.

Responsibilities

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.
Documents 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 training and manuals.
Responsible to know all updated Medi-cal and Medicaid policies and billing specifics and communicate to PFS management, Registration and Coding as applicable.
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.