Patient Account Specialist I

NEMS; Daly City (CA); On-site; USD 30,000 - 39,000; Full time

Benefits offered by this job

Free medical insurance

Dental insurance

Vision insurance

401(k) plan

Job summary

NEMS is seeking a Patient Account Specialist I to manage EOB interpretations, billings, and payer communications for FQHC and FFS reimbursement. You will verify payments, resolve denials, and ensure accuracy of charge capture while maintaining HIPAA compliance.

Ideal candidates have an AA/AS (or higher), healthcare billing experience, and proficiency with CPT/ICD-10 CM. You’ll support training across Billing and front desk staff and uphold high customer service standards in a busy health system

Qualifications

• : Completion of AA/AS degree is required and a 4-year university diploma is preferred.
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Responsibilities

• Reviews, edits, processes and submits electronic and hardcopy claims to various payers for FQHC and FFS reimbursement to ensure accuracy
• Maintains up-to-date billing information on Medicare, Medicaid, Medi-Cal and other payers
• Responds to payer requests and remittance advices in a prompt and professional manner
• Researches and resolves outstanding claims on aging reports
• Answers patient inquiries and billing complaints by making adjustments and ensuring proper follow-up
• Posts charges and submits claims for NEMS physicians’ hospital visits
• Provides training for Billing Department and front desk staff
• Adheres to policies for billing records retention
• Acts as liaison between physicians, insurance companies and third parties to verify invoices and reimbursements
• Performs other duties as required by management

Skills

Analytical skills

Communication skills

Computer skills

Business correspondence

Education

AA/AS degree

Bachelors preferred

Tools

Epic PB Resolute

Job description

The Patient Account Specialist I interprets EOBs for correct payment verification, adjustments, and denials. The Patient Account Specialist I is also responsible for handling outstanding claims on aging reports and resolving patient inquiries regarding billing statements and insurance overage-related matters. The Patient Account Specialist I has to maintain up-to-date knowledge about CPT, ICD-10 CM, billing regulations, and payers' requirements. The Patient Account Specialist I has to comply with HIPAA guidelines and maintain confidentiality regarding patient account status and the organization's financial affairs.

ESSENTIAL JOB FUNCTIONS:

• Reviews, edits, processes and submits electronic and hardcopy claims to various payers (Medicare,Medicaid,ManagedCareandPrivateInsurance)forFQHC(FederallyQualifiedHealth Centers) and FFS (Fee-For-Service) reimbursement to ensure accuracy of payment entries and completeness of charge capturedinformation
• Maintains most up-to-date medical billing information & requirements on (Federally Qualified HealthCenter)FQHCMedi-Cal&Medicare,State,localprogramsandprivateinsurancespayer
• Reports any problems or payment trends to their supervisor (i.e. charges applied to wrong visit, incorrect billing codesetc.)
• Researches and resolves outstanding claims on aging reports
• Responds to payer requests and remittance advices – including, but not limited to, telephonecalls, letter responses, appeals, submitting of medical records and additional information as requested – in a prompt and professionalmanner
• 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 properfollow-up
• Posts charges and submits claims for NEMS physicians’ hospitalvisits
• Provides assistance and trainings for Billing Department and also the front desk staff of Member Services, Medical, Dental, Optometry, Laboratory, and Radiology Departments
• Adheres to policies and procedures for billing recordsretention
• Acts as a liaison between physicians, insurance companies and third party organizations by processing and verifying invoices, ensuring claims reimbursements and auditing patientaccounts
• Performs other job duties as required by manager/supervisor

The Patient Account Specialist I interprets EOBs for correct payment verification, adjustments, and denials. The Patient Account Specialist I is also responsible for handling outstanding claims on aging reports and resolving patient inquiries regarding billing statements and insurance overage-related matters. The Patient Account Specialist I has to maintain up-to-date knowledge about CPT, ICD-10 CM, billing regulations, and payers' requirements. The Patient Account Specialist I has to comply with HIPAA guidelines and maintain confidentiality regarding patient account status and the organization's financial affairs.

ESSENTIAL JOB FUNCTIONS:

• Reviews, edits, processes and submits electronic and hardcopy claims to various payers (Medicare,Medicaid,ManagedCareandPrivateInsurance)forFQHC(FederallyQualifiedHealth Centers) and FFS (Fee-For-Service) reimbursement to ensure accuracy of payment entries and completeness of charge capturedinformation
• Maintains most up-to-date medical billing information & requirements on (Federally Qualified HealthCenter)FQHCMedi-Cal&Medicare,State,localprogramsandprivateinsurancespayer
• Reports any problems or payment trends to their supervisor (i.e. charges applied to wrong visit, incorrect billing codesetc.)
• Edits charges/claims detail, corrects charges/claim submission errors
• Researches and resolves outstanding claims on aging reports
• Responds to payer requests and remittance advices – including, but not limited to, telephonecalls, letter responses, appeals, submitting of medical records and additional information as requested – in a prompt and professionalmanner
• 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 properfollow-up
• Posts charges and submits claims for NEMS physicians’ hospitalvisits
• Provides assistance and trainings for Billing Department and also the front desk staff of Member Services, Medical, Dental, Optometry, Laboratory, and Radiology Departments
• Adheres to policies and procedures for billing recordsretention
• Acts as a liaison between physicians, insurance companies and third party organizations by processing and verifying invoices, ensuring claims reimbursements and auditing patientaccounts
• Performs other job duties as required by manager/supervisor

QUALIFACATIONS:

• Completion of an AA/AS degree is required and a 4-year university diploma ispreferred
• Working experience in a healthcare or FQHC setting ispreferred
• Working experience with Epic PB Resolute is preferred
• Familiar with Medicare, Medicaid, Private insurances, Managed Care (HMO & PPO), CPT, and ICD-10 CM
• Must have excellent analytical and communicationskills
• Must be proficient incomputer skills
• Ability to write businesscorrespondence
• Strong organizational skills to coordinate multiple, varied billingprocessessimultaneously
• Upholds high customer service standards in a demanding and complex health careorganization
• Demonstrates initiative, resourcefulness, integrity and dedication to timeliness to achieve high customer satisfactionlevels
• Self-motivated, diligent, organized, resourceful, responsible, andenthusiastic

LANGUAGE:

• Proficient in written and spoken English and Chinese (Cantonese and/or Mandarin)
• Fluent in other languages is an asset

STATUS:

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).