PIH Health
Patient Account Representative, Home Health/Hospice, Full-time, 8am – 4:30pm (*W
PIH Health, Whittier, California, us, 90607
Overview
Under the supervision of the Patient Accounting and HIM Manager, this position is responsible for the timely and accurate billing of commercial/group insurance/Medicare/Medi-Cal/managed care and self-pay home health/hospice accounts, posting of payments/remittance advices, review of unpaid claims/patient accounts, and use of procedural guidelines to reduce the outstanding dollars on accounts receivable. This includes the billing and electronic submission of claims; performing consistent collection and accounts receivables follow-up practices; processing and posting of payments; identification and preparation of appropriate write-offs; accurate resolution of all credit balances, and timely response to assigned payer correspondence to ensure proper claim reimbursement. It also requires understanding Home Health and Hospice billing rules and compliance with federal, state billing requirements, and adherence to payer contracted billing requirements. Verifies all pertinent data for completeness and accuracy. Collaborates with all teams and payers to effectively process clean claims, obtain reimbursement, and resolve patient accounts. PIH Health is a nonprofit regional healthcare network serving approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region.
Responsibilities
Bill and electronically submit claims for commercial/group insurance, Medicare, Medi-Cal, managed care, and self-pay home health/hospice accounts.
Post payments and remittance advices; review unpaid claims and patient accounts; follow up on accounts receivable to reduce outstanding balances.
Review and resolve all credit balances and respond timely to payer correspondence to ensure proper reimbursement.
Identify and prepare appropriate write-offs as needed.
Maintain compliance with Home Health and Hospice billing rules and federal/state billing requirements; ensure adherence to payer contracted billing requirements.
Verify data for completeness and accuracy; collaborate with teams and payers to process clean claims and resolve issues.
Stay informed of applicable CMS rules and regulations concerning accurate claims submission; interpret ERAs and SPRs as needed.
Qualifications Required Skills
Competency in the use of a computer, 10-key adding machine, calculator, fax machine, photocopy machine, and multi-phone line.
Ability to perform multiple tasks, good mathematical skills, sound decision-making abilities, and good verbal and written communication skills.
Comprehensive knowledge in word processing and spreadsheets (Excel and Word), and ability to learn new computer systems and software.
Must be able to prioritize and complete duties in a timely manner to accomplish both individual and team goals.
Required Experience
High school graduate
Minimum two (2) years in home health/hospice commercial and group insurance billing and collection experience.
Knowledge of commercial/group insurance HMOs/PPOs, Medicare, Medi-Cal billing requirements and regulations.
Understanding of CMS rules and regulations concerning accurate claims submission.
Knowledge of payment posting, proficient in reading and comprehending ERAs and SPRs
Preferred
Two years’ college or medical billing certification
Medical terminology knowledge
Competency in the use of a computer, 10-key adding machine, calculator, fax machine, photocopy machine, and multi-phone line.
Ability to perform multiple tasks, good mathematical skills, sound decision-making abilities, and good verbal and written communication skills.
Comprehensive knowledge in word processing and spreadsheets (Excel and Word), and ability to learn new computer systems and software.
Must be able to prioritize and complete duties in a timely manner to accomplish both individual and team goals.
High school graduate
Minimum two (2) years in home health/hospice commercial and group insurance billing and collection experience.
Knowledge of commercial/group insurance HMOs/PPOs, Medicare, Medi-Cal billing requirements and regulations.
Understanding of CMS rules and regulations concerning accurate claims submission.
Knowledge of payment posting, proficient in reading and comprehending ERAs and SPRs
Preferred
Two years’ college or medical billing certification
Medical terminology knowledge
PIH Health
#J-18808-Ljbffr
Responsibilities
Bill and electronically submit claims for commercial/group insurance, Medicare, Medi-Cal, managed care, and self-pay home health/hospice accounts.
Post payments and remittance advices; review unpaid claims and patient accounts; follow up on accounts receivable to reduce outstanding balances.
Review and resolve all credit balances and respond timely to payer correspondence to ensure proper reimbursement.
Identify and prepare appropriate write-offs as needed.
Maintain compliance with Home Health and Hospice billing rules and federal/state billing requirements; ensure adherence to payer contracted billing requirements.
Verify data for completeness and accuracy; collaborate with teams and payers to process clean claims and resolve issues.
Stay informed of applicable CMS rules and regulations concerning accurate claims submission; interpret ERAs and SPRs as needed.
Qualifications Required Skills
Competency in the use of a computer, 10-key adding machine, calculator, fax machine, photocopy machine, and multi-phone line.
Ability to perform multiple tasks, good mathematical skills, sound decision-making abilities, and good verbal and written communication skills.
Comprehensive knowledge in word processing and spreadsheets (Excel and Word), and ability to learn new computer systems and software.
Must be able to prioritize and complete duties in a timely manner to accomplish both individual and team goals.
Required Experience
High school graduate
Minimum two (2) years in home health/hospice commercial and group insurance billing and collection experience.
Knowledge of commercial/group insurance HMOs/PPOs, Medicare, Medi-Cal billing requirements and regulations.
Understanding of CMS rules and regulations concerning accurate claims submission.
Knowledge of payment posting, proficient in reading and comprehending ERAs and SPRs
Preferred
Two years’ college or medical billing certification
Medical terminology knowledge
Competency in the use of a computer, 10-key adding machine, calculator, fax machine, photocopy machine, and multi-phone line.
Ability to perform multiple tasks, good mathematical skills, sound decision-making abilities, and good verbal and written communication skills.
Comprehensive knowledge in word processing and spreadsheets (Excel and Word), and ability to learn new computer systems and software.
Must be able to prioritize and complete duties in a timely manner to accomplish both individual and team goals.
High school graduate
Minimum two (2) years in home health/hospice commercial and group insurance billing and collection experience.
Knowledge of commercial/group insurance HMOs/PPOs, Medicare, Medi-Cal billing requirements and regulations.
Understanding of CMS rules and regulations concerning accurate claims submission.
Knowledge of payment posting, proficient in reading and comprehending ERAs and SPRs
Preferred
Two years’ college or medical billing certification
Medical terminology knowledge
PIH Health
#J-18808-Ljbffr