Patient Account Lead Commercial / Medicare / Medi-Cal and Managed Care Insurance Follow Up
Patient Account Lead Commercial / Medicare / Medi-Cal and Managed Care Insurance Follow Up
Employer Active
Job Alert
You will be updated with latest job alerts via email
Share
Job Alert
You will be updated with latest job alerts via email
Job Description
Under the supervision of the Insurance Follow up Supervisor / Manager this position is responsible for training employees to perform accurate and timely follow up of Commercial and Senior Managed care claims and all payer mix through resolution. Serves as a resource on PM computer systems and Contract specific regulations. Assists with follow up assists with report analysis and review and reviews correspondence assuring corrective action is done. Meet and exceed the minimum productivity volume and standards of work as defined within the departmental policies and procedures includes billing and followup of appropriate billing guidelines HIPAA rules and regulations collection and followup activities identification and processing of appropriate claim submission to appropriate Insurance Plan review/submission of appropriate contractual adjustments writeoffs credit balances and correspondence from various MediCal and or Managed Care HMO Plans. Review of MediCal and Managed Care HMO secondary to Primary Medicare and or Commercial Insurances. Using PM software and tools provided to read and interpret specific Managed Care HMO Contracts and or Division of Financial Responsibility (DOFRs) MediCal Managed Care HMO Contracted PPG and PHP Matrixes to submit bill and or resubmit claims to the appropriate MediCal/Managed Care HMO and commercial insurance plans.
PIH Health is a nonprofit regional healthcare network that serves approximately 3 million residents in the Los Angeles County Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Downey Hospital PIH Health Good Samaritan Hospital PIH Health Whittier Hospital 37 outpatient medical office buildings a multispecialty medical (physician) group home healthcare services and hospice care as well as heart cancer digestive health orthopedics womens health urgent care and emergency services. The organization is nationally recognized for excellence in patient care and patient experience and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nations top hospital systems for best practices cuttingedge advancements quality of care and healthcare technology. For more information visit follow us onFacebookTwitter orInstagram.
Required Skills
- Computer experience is essential including but not limited to: Professional claims Financial Systems Microsoft Office Excel and Word processing Internet applications Payer websites with a minimum of 40 wpm typing speed and 10key by touch. Calculator fax machine photocopy machine.
- Ability to perform multiple tasks good mathematical skills sound decisionmaking abilities and good verbal and written communication skills.
- Knowledge and or familiarity of CPT4 HCPCS ICD10 codes and medical terminology.
- Experience in followup filing of Provider Grievance/Appeals Claim Inquiry Forms (CIF) PDRs (Provider Resolution Dispute Request) with Medical/ Managed Care HMO and Commercial Insurance Plans to ensure maximum entitled reimbursement.
- Ability to learn new systems become proficient in development of reports via PM systems and tools provided proficient in excel and word document for training and QRGs.
- Familiarity with Commercial third party and Government billing requirements.
- Understanding of Medicare CMS rules and regulations related to accurate claims submission.
- Knowledge of insurance and government billing guidelines and regulations.
Employment Type
Unclear
