PATIENT ACCOUNT SPECIALIST I

NORTH EAST MEDICAL SERVICES•Daly City, CA

11d•$32 - $36

About The Position

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.

Requirements

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.
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
Proficient in written and spoken English and Chinese (Cantonese and/or Mandarin)

Nice To Haves

Working experience in a healthcare or FQHC setting is preferred
Working experience with Epic PB Resolute is preferred
Fluent in other languages is an asset

Responsibilities

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.