PATIENT ACCOUNT SPECIALIST I

NORTH EAST MEDICAL SERVICES•Daly City, CA

13d•$32 - $36

About The Position

The Patient Account Specialist I interprets EOBs to verify payments, make adjustments, and address denials. The role manages outstanding claims identified on aging reports and responds to patient questions about billing statements and insurance overages. The specialist maintains current knowledge of CPT, ICD-10 CM, billing regulations, and payer requirements while protecting confidential patient-account and organizational financial information in accordance with HIPAA. The position reviews, edits, processes, and submits electronic and hardcopy claims for FQHC and fee-for-service reimbursement. It also responds to payer requests and remittance advices, resolves claim and billing issues, posts charges for NEMS physicians’ hospital visits, and supports billing and front-desk staff across several departments. Under the guidance of a Patient Account Specialist II, the specialist helps address patient billing inquiries and complaints, escalating complex matters as appropriate. This is a full-time, FLSA non-exempt position located in Daly City, California.

Requirements

Completion of an AA/AS degree is required.
A four-year university diploma is preferred; it may be substituted with a minimum of three years of work experience in healthcare.
Familiarity with Medicare, Medicaid, private insurance, managed care (HMO and PPO), CPT, and ICD-10 CM.
Excellent analytical and communication skills.
Proficiency in computer skills.
Ability to write business correspondence.
Strong organizational skills to coordinate multiple, varied billing processes simultaneously.
Ability to uphold high customer-service standards in a demanding and complex healthcare organization.
Demonstrated initiative, resourcefulness, integrity, and dedication to timeliness to achieve high customer satisfaction.
Self-motivated, diligent, organized, resourceful, responsible, and enthusiastic.
Proficient written and spoken English and Chinese (Cantonese and/or Mandarin).

Nice To Haves

Working experience in a healthcare or FQHC setting.
Working experience with Epic PB Resolute.
Fluency in other languages.

Responsibilities

Review, edit, process, and submit electronic and hardcopy claims to Medicare, Medicaid, managed care, and private insurance payers for FQHC and fee-for-service reimbursement.
Ensure accuracy of payment entries and completeness of charge-capture information.
Maintain current knowledge of medical billing requirements for FQHC Medi-Cal, Medicare, state and local programs, and private insurance payers.
Report issues and payment trends, such as charges applied to the wrong visit or incorrect billing codes, to the supervisor for resolution.
Edit charge and claim details and correct submission errors.
Research and resolve outstanding claims on aging reports to minimize reimbursement delays.
Respond promptly and professionally to payer requests and remittance advices through calls, letters, appeals, and submission of medical records or other requested information.
Under the guidance of a Patient Account Specialist II, address patient inquiries and billing complaints, make necessary adjustments, explore options to secure claim payments, refer complex issues to appropriate staff, and ensure follow-up.
Post charges and submit claims for NEMS physicians’ hospital visits.
Provide training and support to Billing Department and front-desk staff in Member Services, Medical, Dental, Optometry, Laboratory, and Radiology Departments.
Follow policies and procedures for billing-record retention.
Act as a liaison among physicians, insurance companies, and third-party organizations by processing and verifying invoices, ensuring claim reimbursements, and auditing patient accounts.
Perform additional duties as assigned by management.
Comply with HIPAA guidelines and maintain confidentiality regarding patient account status and the organization’s financial affairs.