Job Summary

Responsible for the collection of outstanding balances from all commercial, managed care and governmental payers. Manages and assembles all data and documents required for accurate follow-up of claims. Responds to payer inquiries.

Responsible for identifying follow-up to problems and issues and checks status of claims by telephone, websites, clearinghouses and/or other means available. Reviews payer denials and communication and implements correction, claim re-direction, re-bills and appeals as necessary. Proactively works aging reports / tasks to facilitate appropriate payments. Responsible for providing information and documentation to ensure timely and accurate reimbursement including additional record requests and appeals to meet timely filing requirements. Coordinates with coding department with payer requests or adjustments as necessary. Appropriately apply account adjustments and movement of balance responsibility to appropriate parties. Processes and corrects payer edits / EDI rejections to ensure claims are ready for payer adjudication. Responsibilities include researching, reviewing, and adhering to all federal, state, and local regulatory billing guidelines, as well as payer specific billing guidelines. Optimizes the total collected value of each patient account to appropriately bill all responsible parties through the claim lifecycle. Documents payer, patient and guarantor communications and attaches appropriate correspondence and documents to patient account. Processes patient refund requests per departmental policy in a timely manner. Creates patient budget plans and facilitates hardship requests as necessary. Facilitate and obtain share of cost deposits. Intermediate Knowledge of medical billing rules, such as coordination of benefits, modifiers, Medicare, and Medicaid and understanding of EOBs preferred. Become proficient in the use of billing software within 4 weeks and maintain proficiency. Ability to communicate with diverse personalities in a tactful, mature, and professional manner.

Maintains high productivity and quality with minimal supervision. Works in collaboration with internal and external customers. Customer service and satisfaction are a key standard for all communications. Work will be subject to compliance reviews and productivity standards. Yearly continuing education is required. Speak and read English at a level that is sufficient to satisfactorily perform the essential functions of the position. Knowledge of standard office equipment (i.e., calculator, fax, photocopier) and personal computer and computer software skills (i.e., MS Windows, Excel, Access, Word, PowerPoint, internet, e-mail). Windows computer skills including proficient use of keyboarding, use of mouse or keys for functions such as selecting items, use of drop-down menus, scroll bars, opening folders, copying and similar operations required upon employment or within the 1st two weeks of employment to perform the essential functions of the job. Performs other duties as assigned. Follows Palomar Health Medical Group rules, policies, procedures, applicable laws, and standards. Carries out the mission, vision, and quality commitment of Palomar Health Medical Group.

Job Requirements

Minimum Education: High School Diploma or combination of education and experience

Preferred Education: Associate’s or bachelor’s degree in accounting, business, or finance

Minimum Experience: 2 years’ patient accounting experience or experience in a similar field or associate degree or higher in lieu of experience

Preferred Experience: Bilingual English and Spanish

Required License: Not Applicable

Preferred License: Not Applicable

Required Certification: Not Applicable

Preferred Certification: Medical Billing or Coding Certification