Patient Account Services Representatives

AMPLA HEALTH; Yuba City (CA); On-site; USD 45,000 - 65,000; Full time

Job summary

Ampla Health is seeking a Patient Account Services Representative to manage the revenue cycle for various payer sources, from pre-billing reviews to follow-up of denials. The role includes entering charges, verifying CPT/ICD-10 codes, and ensuring accurate billing across Medicare, Medi-Cal, private insurances, and sliding fee programs.

The ideal candidate will have a high school diploma, at least two years of insurance billing experience, knowledge of CPT/ICD-10 codes, and strong communication

Qualifications

• High school diploma or equivalent.
• At least two years of insurance billing experience with CPT and ICD-10 knowledge.
• Knowledge of hospital and dental billing.
• Ability to type at least 40 WPM and use Microsoft Word.
• Strong communication and patient-service skills.
• Ability to adapt to specific environment and duties.

Responsibilities

• Review claims prior to billing and intervene when needed.
• Monitor, correct and re-bill claims for Medicare, Medi-Cal, and other payers.
• Enter hospital charges and ensure proper CPT/ICD-10 codes.
• Verify eligibility and PPS rates; follow up on denials.
• Post payments and set up payment plans as needed.
• Answer patient inquiries and manage mail and deposits.

Skills

Insurance billing

CPT Codes

ICD-10 Codes

Microsoft Word

Typing 40 WPM

Patient interaction

Communication skills

Hospital billing

Dental billing

Primary health care

Education

High school diploma or equivalent

Job description

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 &CHARACTERISTICSMaintains a professional relationship and positive attitude with co-workers, the public, patients and all Ampla HealthMaintains the highest professional ethics and is honest in dealing with people; is a model for all employees through his/her actionsStrives to learn more and is receptive to learning different ways of doing thingsDisplays enthusiasm toward the work and the missions of Ampla HealthPROFESSIONAL KNOWLEDGE, SKILLS & ABLITIESMust have high school diploma or equivalentAbility to use Microsoft Word for basic correspondenceAbility to type a minimum of 40 WPMMinimum of two years prior insurance billing experience, with knowledge of CPT Codes and ICD 10 CodesKnowledge of hospital and dental billingKnowledge of primary health care conceptsAbility to adapt to specific environment and dutiesCOMMUNICATIONS SKILLSMust have neat and legible handwritingMust be able to interact with patients courteously and calmlyAbility to communicate well with the publicWORKING CONDITIONS AND PHYSICAL REQUIREMENTSWorks 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 staffMust 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 documentsMust have high manual dexterityAble to reach above shoulder level to work, must be able to bend, squat and sit, stand, stoop, crouch, reach, kneel, twist/turnMay be exposed to contagious/infectious diseasesPROFESSIONAL KNOWLEDGE, SKILLS & ABLITIESMust have high school diploma or equivalentAbility to use Microsoft Word for basic correspondenceAbility to type a minimum of 40 WPMMinimum of two years prior insurance billing experience, with knowledge of CPT Codes and ICD 10 CodesKnowledge of hospital and dental billingKnowledge of primary health care conceptsAbility to adapt to specific environment and dutiesCOMMUNICATIONS SKILLSMust have neat and legible handwritingMust be able to interact with patients courteously and calmlyAbility to communicate well with the public