Patient Account Assistant

CommonSpirit Health•Rancho Cordova, CA

1d•Onsite

About The Position

This patient account assistant is responsible for administering complex payable functions as related to Medicare risk contracts, commercial capitation. This position is also expected to calculate and submit reinsurance claims by merging multiple systems data downloads into spreadsheets and employing complex pricing methodology to value all internal and external capitated claims on an as needed basis. This position will be responsible to pull queries and reports from claims databases for Managed Care Contracting, General Ledger and other management as needed. Verify authorization in IDX, with health care provider, complete benefit determination, process complex claims with manual calculations using current National Drug Codes and Average Wholesale Pricing in IDX system, at a maximum of 8 claims per hour with less than 1% errors Research and answer telephone inquiries from providers and members Prepare monthly and quarterly compliance reports for claims timeliness and provider disputes Report any non-compliant issues with regards to C.I.A. guidelines to management prior to processing Process all voids and replacement claims. Enter all refunds to IDX. Handle all refund checks for the department

Requirements

Three years of clerical experience in medical claims adjudication or Equivalent combination of education and experience

Nice To Haves

Associates in Applied science in medical billing and claims adjudication or equivalent, upon hire

Responsibilities

Administer complex payable functions as related to Medicare risk contracts, commercial capitation.
Calculate and submit reinsurance claims by merging multiple systems data downloads into spreadsheets and employing complex pricing methodology to value all internal and external capitated claims on an as needed basis.
Pull queries and reports from claims databases for Managed Care Contracting, General Ledger and other management as needed.
Verify authorization in IDX, with healthcare provider, complete benefit determination.
Process complex claims with manual calculations using current National Drug Codes and Average Wholesale Pricing in IDX system, at a maximum of 8 claims per hour with less than 1% errors.
Research and answer telephone inquiries from providers and members.
Prepare monthly and quarterly compliance reports for claims timeliness and provider disputes.
Report any non-compliant issues with regards to C.I.A. guidelines to management prior to processing.
Process all voids and replacement claims.
Enter all refunds to IDX.
Handle all refund checks for the department.