PATIENT ACCOUNT SPECIALIST I

North East Medical Services; Daly City (CA); On-site; USD 52,000 - 78,000; Full time

Benefits offered by this job

Competitive benefits package

401(k) company contribution

Free medical, dental and vision for员工及

Job summary

North East Medical Services is seeking a Patient Account Specialist I to manage claims for FQHC and fee-for-service care in a fast-paced environment. You will verify billing accuracy, resolve denials, and respond to payer inquiries, while maintaining HIPAA confidentiality.

You will work with Epic PB Resolute, stay current on CPT/ICD-10 coding, and coordinate with physicians, insurance companies, and staff to ensure timely reimbursement.

Qualifications

• AA/AS degree required; a four-year degree preferred or equivalent with 3 years healthcare experience.
• Experience in FQHC or healthcare billing is preferred.
• Familiarity with CPT/ICD-10 and payer requirements.

Responsibilities

• Reviews, edits, processes, and submits electronic and hardcopy claims for various payers.
• Maintains knowledge of billing requirements for Medi-Cal, Medicare, and private payers.
• Resolves aging reports and outstanding claims to minimize delays.
• Responds to payer requests and remittance advices professionally.
• Addresses patient inquiries and follows up on complex issues with staff.
• Posts charges and submits claims for physicians’ hospital visits.
• Trains Billing and front desk staff in multiple departments.
• Acts as liaison between physicians, payers, and third-party organizations.

Skills

Analytical skills

Communication skills

Bilingual English/Chinese

Microsoft Excel

Education

AA/AS degree required

Bachelor's degree preferred

Healthcare experience optional

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, Managed Care, and Private Insurance) for FQHC (Federally Qualified Health Centers) and FFS (Fee-For-Service) reimbursement, ensuring accuracy of payment entries and completeness of charge capture information.Maintains up-to-date knowledge of medical billing requirements for FQHC Medi-Cal, Medicare, state, local programs, and private insurance payers.Reports issues or payment trends (e.g., charges applied to the wrong visit, incorrect billing codes) to the supervisor for resolution.Edits charge/claim details and corrects submission errors to ensure accuracy.Researches and resolves outstanding claims on aging reports to minimize delays in reimbursement.Responds to payer requests and remittance advices promptly and professionally, including phone calls, letter responses, appeals, and submission of medical records or additional information as required.Under the guidance of the Patient Account Specialist II, addresses patient inquiries and billing complaints by making necessary adjustments, exploring all options to secure claim payments, referring complex issues to appropriate staff, and ensuring proper follow-up.Posts charges and submits claims for NEMS physicians’ hospital visits.Provides training and support to the Billing Department and front desk staff in Member Services, Medical, Dental, Optometry, Laboratory, and Radiology Departments.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 claim reimbursements, and auditing patient accounts.Performs additional duties as assigned by management.Completion of an AA/AS degree is required, and a 4-year university diploma is preferred or maybe substituted with a minimum of 3 years of work experience in healthcare.Working experience in a healthcare or FQHC setting is preferredWorking experience with Epic PB Resolute is preferredFamiliar with Medicare, Medicaid, Private insurances, Managed Care (HMO & PPO), CPT, and ICD-10 CMMust have excellent analytical and communication skillsMust be proficient in computer skillsAbility to write business correspondenceStrong organizational skills to coordinate multiple, varied billing processes simultaneouslyUpholds high customer service standards in a demanding and complex health care organizationDemonstrates initiative, resourcefulness, integrity and dedication to timeliness to achieve high customer satisfaction levelsSelf-motivated, diligent, organized, resourceful, responsible, and enthusiasticLANGUAGE:Proficient in written and spoken English and Chinese (Cantonese and/or Mandarin)Fluent in other languages is an assetSTATUS:This is an FLSA Non-exempt position.This is not an OSHA high-risk position.This is a Full Time position.NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).