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Patient Account Representative Lead (Medi-Cal Billing and Collections and Managed Medi-Cal Billing), Remote

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Location: Fountain Valley, California

Schedule: Full-time

Shift: Full-time

Job Listing: MEM006060

The Medi-cal Patient Account Representative, Lead, is responsible for assisting staff with the Medi-cal billing and/or collection of accounts to ensure that PFS is capturing all revenues as timely and efficiently as possible.  This position will have working knowledge and understanding of managed care 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 Medi-cal payors and government agencies to obtain maximum and correct reimbursement of accounts receivables.  This position proactively interacts with insurance companies, government agencies and/or patients to obtain maximum and correct reimbursement of accounts receivable.  In addition, this position works with all payors and internal resources to identify and resolve issues that hinder account payment.  Applies independent judgment, research and knowledge to audit payor payments, denials, appeals and billing issues. Assists with department workload and provides support to staff, as directed.  Supports Management with day-to-day operations and works closely with the department Coordinator to ensure a high level of performance with a commitment to continuous improvement.

Job Responsibilities

  • Researches and responds to Medi-Cal payer inquiries timely, effectively and according to policies and procedures resulting in resolution
  • Point of contact for escalation of claims issues.
  • Responsible for Hospital Fee program functions.
  • Backup for billing and works special projects.
  • At all times, provides professional and exceptional customer service while interacting with internal and external customers resulting in resolution.
  • Documents all communications in the financial system and updates demographics ensuring accuracy and appropriate information to move the account towards payment resolution
  • Meets quality assessment goals as set by Management.
  • Reviews and processes Medi-cal payor refunds in the financial system by ensuring the refund amount is accurate and appropriate.  
  • Uses critical thinking skills to monitor and follow-up on Medi-cal claims to ensure correct reimbursement is received in a timely manner with minimal supervision.
  • Demonstrates and shares knowledge of Medi-cal payor hospital account management, billing and collections skills with staff while educating and offers assistance, when needed. 
  • Demonstrates appropriate, aggressive telephone and/or online follow-up as necessary to expedite payment of billed charges with minimal supervision.
  • Makes suggestions for enhancements within the department and seeks to improve billing and collection efforts.
  • Responsible for training, productivity, and gaps in time logs.
  • Works collaboratively with Manager and Coordinator to create department specific guidelines and tip sheets.               
  • “Other duties as assigned

Experience

  • Minimum 4 years’ experience and understanding of Medi-Cal/Managed Medi-cal hospital billing and Medi-Cal collections processes, required
  • Excellent interpersonal skills
  • Understand and follow oral and written instructions
  • Positive work ethics
  • Bi-lingual preferred
  • Knowledge of medical terminology and coding, preferred
  • Written and verbal communication skills to meet productivity standards
  • Use of 10-key calculator by touch preferred
  • Microsoft Office and Outlook experience 

Education

  • High School diploma, GED equivalent, preferred
  • Business related courses, preferred
  • AA Degree or medical field certificate, preferred

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 trainings, meetings, etc. as needed.

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Photo of Brindilyn Berger
"I love working at Miller Children's & Women's Hospital Long Beach because I value working for a company that invests in its employees and the community we serve. From the support and guidance I receive from managers who value my professional and personal growth; to being able to work alongside colleagues who are dedicated to help their patients and families. I feel inspired every day to do the work that I love alongside people who share a similar vision."
- Brindilyn Berger, Child Life Specialist

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