Title: Patient Account Representative, Senior

Location: Fountain Valley

Department: MCSS Patient Accounting

Status: Full-time

Shift: Days

Pay Range: $24.49/hr - $35.50/hr

MemorialCare is a nonprofit integrated health system that includes four leading hospitals, award-winning medical groups – consisting of over 200 sites of care, and more than 2,000 physicians throughout Orange and Los Angeles Counties. We are committed to increasing access to patient-centric, affordable, and high-quality healthcare; your personal contributions are integral to MemorialCare's recognition as a market leader and innovator in value-based and other care models.

Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration, and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation, and teamwork.

Purpose Statement / Position Summary

Commercial and Managed MCAL Patient Account Representative, Senior is responsible for all Commercial and Managed MCAL insurance 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 and understanding of Commercial managed care and Managed MCAL contracts including other complex payment methodologies to ensure prompt and accurate reimbursement. This position must be able to utilize and understand many complex and varying State and Federal statutes and regulations, guidelines, and systems, and perform the account follow-up function with all Commercial payors, Managed MCAL payors and 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, research, and knowledge to audit Commercial and Managed MCAL payor payments, denials, appeals and billing issues.

This position offers you the opportunity to work from home (WFH) after all training has been completed. Once completed you will need to be available to come into the office for additional training, meetings etc., as needed.

Essential Functions and Responsibilities of the Job

1.Ability to provide prompt and courteous customer service to all internal and external customers.

2.Ability to use critical thinking to research, review, and follow-up on all accounts.

3.Ability to communicate effectively in verbal and written form.

4.Ability to analyze documentation and resolve patient, billing and/or collection issues appropriately and timely.

5.Ability to work independently with minimal supervision.

6.Ability to identify and analyze problems in a timely manner and independently initiate appropriate actions to resolve problems or issues.

7.Able to be at work and on time, follow organization rules and procedures and directions from a Coordinator/Lead or other member of the Management staff.

8.Adheres to all confidentiality policies and procedures and carries out all tasks in a pleasant and respectful manner.

9.Ability to make suggestions for enhancements throughout the department and continually seeks opportunities to improve current policies, procedures, and practices.

10.Ability to recognize and perform essential duties and help others or perform other required tasks when own assignments are completed.Performs other duties as assigned by management.

11.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.

12.Be at work and be on time.

13.Follow company policies, procedures, and directives.

14.Interact in a positive and constructive manner.

15.Prioritize and multitask.

*Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities. Health and wellness is our passion at MemorialCare—that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there’s more...Check out our MemorialCare Benefits for more information about our Benefits and Rewards.

Experience

Minimum 1 year hospital business office experience (required)

Acute Care Hospital Collections experience (required)

Understanding of managed care (PPO, HMO, Medicare Advantage and Managed Medi-Cal) insurance collection processes including denial resolution and appeals (required)

Excellent interpersonal skills

Positive work ethics

Bi-lingual preferred

Knowledge of medical terminology and coding

Written and verbal communication skills to meet productivity standards.

Microsoft Office and Outlook experience 

Education

High School diploma, GED equivalent, preferred.

Business-related courses preferred.

AA Degree or medical field certificate, preferred.