Patient Account Lead Commercial Medicare MediCal and Managed Care Insurance Foll

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 types through resolution. Serves as a resource on PM computer systems and contract-specific regulations. Assists with follow-up, report analysis, review, and correspondence to ensure corrective actions are taken. Meets and exceeds minimum productivity volumes and standards of work as defined within departmental policies, including billing and follow-up according to billing guidelines, HIPAA rules, collection activities, and claim submissions to insurance plans. Reviews and submits claims for Medi-Cal and Managed Care HMO plans, including secondary billing to Medicare or Commercial Insurances, utilizing PM software and tools to interpret contracts and regulations for proper claim submission. PIH Health is a nonprofit, regional healthcare network serving approximately 3 million residents in Los Angeles County, Orange County, and the San Gabriel Valley. The network includes hospitals, outpatient facilities, a multispecialty medical group, home healthcare, hospice, and various specialized services. Recognized nationally for excellence in patient care, PIH Health has been acknowledged by CHIME for best practices and healthcare technology. For more information, visit

PIHHealth.org

or follow us on

Facebook ,

Twitter , or

Instagram . Required Skills

Proficient in computer applications including claims financial systems, Microsoft Office, Excel, Word, internet, payer websites, with a minimum of 40 WPM typing speed and 10-key proficiency by touch. Strong multitasking, mathematical, decision-making, and communication skills. Knowledge of CPT4, HCPCS, ICD10 codes, and medical terminology. Experience in follow-up filing of provider grievances, appeals, claim inquiry forms, and dispute requests with Medi-Cal, Managed Care HMO, and Commercial Insurance Plans. Ability to learn and develop reports using PM systems and tools; proficient in Excel and Word for training and quick reference guides. Familiarity with commercial third-party and government billing requirements. Understanding of Medicare CMS rules and regulations for accurate claims submission. Knowledge of insurance and government billing guidelines and regulations. Required Experience

Minimum:

7 years of experience in professional commercial and government follow-up or billing. Preferred:

High school diploma; two years of college preferred.

#J-18808-Ljbffr