Patient Account Services Representative (30384)

Ampla Health; Yuba City (CA); On-site; USD 62,000 - 84,000; Full time

Job summary

Ampla Health is seeking a Patient Account Services Representative in Yuba City, CA to manage revenue cycle activities from pre-billing through post-billing follow-up. You will review claims, ensure correct CPT/ICD-10 coding, verify eligibility, and monitor payments across Medicare, Medi-Cal, and private insurances.

Strong attention to detail and familiarity with hospital/dental billing are essential. The role requires proficiency in Word, typing speed, and prior billing experience.

Qualifications

• Must have high school diploma or equivalent.
• Experience with CPT/ICD-10 coding and hospital/dental billing.
• Knowledge of payer claims processing and billing procedures.
• Proficiency in Microsoft Word for basic correspondence.

Responsibilities

• Review claims prior to billing and follow manual intervention criteria for each payer source.
• Print billing forms and attach EOBs for non-electronic secondaries.
• Check patient eligibility and resubmit corrected claims as needed.
• Enter hospital charges with correct CPT/ICD-10 codes in the system.
• Verify PPS rates from Medicare and Medi-Cal and monitor other insurance payments.
• Follow up on EOBs and remittance advice with Supervisors; assist with new procedures.

Skills

Microsoft Word

Typing 40 WPM

Insurance billing knowledge

CPT/ ICD-10 codes

Primary health care concepts

Adapt to environment

Education

High school diploma or equivalent

Tools

None

Job description

Job Details

Job Location: Harter Building - Yuba City, CA 95993

Position Type: Full Time

Salary Range: $29.81 - $40.24 Hourly

GENERAL 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