Managed Medi-cal Patient Account Representative, Senior is responsible for all Managed Medi-cal billing and/or collections of accounts to ensure that PFS is capturing all revenues as timely and efficiently as possible. This position takes ownership of their accounts and eliminates barriers to ensure timely and correct payment including involvement with payors upper management, when necessary. This position will have working knowledge of Managed Medi-cal including other complex payment methodologies to ensure prompt and accurate reimbursement. This position must be able to utilize and understand many complex and varying Managed Medi-cal State and Federal statutes and regulations, guidelines and systems, and perform the billing and/or account follow-up function with all Managed Medi-cal government agencies to obtain maximum and correct reimbursement of accounts receivables. This position proactively works with all payors and internal resources to identify and resolve issues that hinder account payment. Applies independent judgment and knowledge to audit Managed Medi-cal payments, denials, appeals and billing issues.
Essential Functions and Responsibilities of the Job * Ability to provide prompt and courteous customer service to all internal and external customers. * Ability to use critical thinking to research, review and follow-up on all accounts. * Ability to communicate effectively in verbal and written form. * Ability to analyze documentation and resolve patient, billing and/or collection issues appropriately and timely. * Ability to work independently with minimal supervision. * Ability to identify and analyze problems in a timely manner and independently initiates appropriate actions to resolve problems or issues. * Able to be at work and on time, follow organization rules and procedures and directions from a Coordinator or other member of the Management staff. * Adheres to all confidentiality policies and procedures and carries out all tasks in a pleasant and respectful manner. * Ability to make suggestions for enhancements throughout the department and continually seeks opportunities to improve current policies, procedures and practices. * Ability to recognize and perform essential duties and offers assistance to others or performs other required tasks when own assignments are completed. Performs other duties as assigned by management. * Ability to use critical thinking while reviewing billing and collection notes in the financial computer system to ensure that the appropriate action is taken within the billing and collection process and to ensure correct hospital reimbursement.
Experience * Minimum 3 years’ experience and understanding of Managed Medi-cal hospital billing and collections processes required * Excellent interpersonal skills * Positive work ethics * Bi-lingual preferred * Knowledge of medical terminology and coding, preferred * Written and verbal communication skills to meet productivity standards * Use of 10-key calculator by touch preferred * Microsoft Office and Outlook experience
Education * High School diploma, GED equivalent required * Business related courses, preferred * AA Degree or medical field certificate, preferred