The Patient Account Specialist I’s processes patient account billings and collections, ensuring that they are processed accurately and timely. They also follow up on Account Receivable balances. The Specialist keeps up-to-date on billing regulations and government and private payer requirements. Being familiar with CPT, ICD-9 codes, modifiers and HCPCS Level II coding guidelines, they adhere to these guidelines. They also provide assistance and offer trainings for Billing Department and a variety of other NEMS staff. The Patient Account Specialist complies with HIPAA guidelines and maintains confidentiality in regards to patient account status and the financial affairs of clinic/corporation.
ESSENTIAL JOB FUNCTIONS:
• Reviews, edits, processes and submits electronic and hardcopy claims to various payers (Medicare, Medicaid, Managed Care and Private Insurance)
for FQHC (Federally Qualified Health Centers) and FFS (Fee-For-Service) reimbursement to ensure accuracy of payment entries and completeness of
charge captured information.
• Maintains most up-to-date medical billing information & requirements on (Federally Qualified Health Center) FQHC Medi-Cal & Medicare, State, local
programs and private insurances payer.
• Reports any problems or payment trends to their supervisor (i.e. charges applied to wrong visit, incorrect billing codes etc.).
• Generates electronic and paper claims, edits claims detail, corrects claim submission errors, runs patient daily receipts, Account Receivable reports,
• Follows up on Accounts Receivable by researching and resolving outstanding claims on aging reports for medical, mental health, optometry and
• Responds to payer requests and remittance advices – including, but not limited to, telephone calls, letter responses, appeals, submitting of medical
records and additional information as requested – in a prompt and professional manner.
• Under the guidance of Patient Account Specialist II, answers patient inquiries and billing complaints by making adjustments as necessary, exercising
all options to obtain claim payments, referring patient inquiries to appropriate staff and ensuring proper follow-up.
• Posts charges and submits claims for NEMS physicians’ hospital visits.
• Provides assistance and offer trainings for Billing Department and also the front desk staff of Member Services, Medical, Dental, Optometry,
Laboratory, Radiology and other departments.
• Audits and reviews credit balance reports.
• Generates and submits monthly payment reports to the Accounting Department.
• Adheres to policies and procedures for billing records retention.
• Acts as a liaison between physicians, insurance companies and third party organizations by processing and verifying invoices, ensuring claims
reimbursements and auditing patient accounts
• Performs other job duties as required by manager/supervisor.
• Completion of an AA/AS degree is required and a 4-year university diploma is preferred
• Prior experience working in a healthcare or medical setting highly preferred
• Prior clerical experience is a plus
• Knowledge of electronic medical records (Nextgen) is a plus
• Knowledge of: Medicare, Medi-Cal, Private insurances, Managed Care (HMO & PPO), CPT, ICD 9/ 10 preferred
• Must have excellent communication skills
• Must be proficient in computers
• Ability to write business correspondence
• Possess excellent analytical skills
• Uphold high standards of customer service in a demanding and complex health care organization.
• Strong Organizational skills to coordinate multiple, varied billing processes simultaneously
• Demonstrated initiative, resourcefulness, integrity and dedication to timeliness to achieve high customer satisfaction levels.
• Self-motivated, diligent, organized, resourceful, responsible and enthusiastic
• Must be able to fluently speak, read and write English.
• Must be able to speak Chinese (Cantonese and/or Mandarin) required
• Fluent in other languages are an asset.
This is an FLSA Non-exempt position.
This is not an OSHA high-risk position.
NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).