Patient Account Lead Commercial / Medicare / Medi-Cal and Managed Care Insurance

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. It serves as a resource on PM computer systems and contract-specific regulations. The role includes assisting with follow-up, report analysis, review, and ensuring corrective actions are taken. The position requires meeting and exceeding minimum productivity volumes and standards of work as defined within departmental policies and procedures. Responsibilities include billing and follow-up according to appropriate billing guidelines, HIPAA rules and regulations, collection activities, and processing of claims to the appropriate insurance plans. It also involves reviewing and submitting claims for Medi-Cal and Managed Care HMO plans, interpreting specific contracts and regulations, and resubmitting claims as necessary. 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. The network includes hospitals, outpatient medical offices, a multispecialty medical group, home healthcare, hospice care, and various specialized services. Recognized for excellence in patient care and experience, PIH Health is also noted for its healthcare technology and best practices. For more information, visit

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Instagram . Computer experience is essential, including: claims financial systems, Microsoft Office, Excel, Word, internet applications, payer websites, with a minimum of 40 wpm typing speed and 10-key by touch. Also includes use of calculator, fax, and photocopy machine. Ability to perform multiple tasks, possess good mathematical skills, sound decision-making abilities, and effective verbal and written communication skills. Knowledge of CPT4, HCPCS, ICD10 codes, and medical terminology. Experience with follow-up filing of Provider Grievance/Appeals, Claim Inquiry Forms (CIF), PDRs with Medi-Cal/Managed Care HMO, and Commercial Insurance Plans to maximize reimbursement. Ability to learn new systems, develop reports using PM tools, and be 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 related to claims submission. Knowledge of insurance and government billing guidelines and regulations. Required: Minimum 7 years of experience in professional commercial and government follow-up and/or billing. Preferred: High school diploma or equivalent. Two years of college education.

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