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 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.)
• 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, 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 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 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
  
  

QUALIFACATIONS

• Completion of an AA/AS degree is required and a 4-year university diploma is preferred
• Working experience in a healthcare or FQHC setting is preferred
• 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 communication skills
• Must be proficient in computer skills
• Ability to write business correspondence
• Strong organizational skills to coordinate multiple, varied billing processes simultaneously
• Upholds high customer service standards in a demanding and complex health care organization
• Demonstrates initiative, resourcefulness, integrity and dedication to timeliness to achieve high customer satisfaction levels
• Self-motivated, diligent, organized, resourceful, responsible, and enthusiastic
  
  

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).