• Job Description

  Req#: 24549 977

  Business Services:

  Under the supervision of the Insurance Billing Manager, this position is responsible for the timely and accurate billing of Commercial, Senior Managed Care and Group insurance inpatient and outpatient accounts and secondary insurance. This includes the pre-billing, billing and electronic submission of hospital claims; identification and processing of appropriate write-offs, accurate use of HMO matrix to identify responsible payer, identification of stop loss claims and “carve out” items that are reimbursed at different rates. Ensures compliance to the payer’s contracted billing requirements. Coordinates with the Medicare and Medi-Cal team for any MSP issues, HMO acknowledgements or Medicare/Medi-Cal as secondary billing. Meet and exceed the minimum productivity volume, and standards of work as defined within the departmental policies and procedures.

  Patient Account Representative Medicare Billing & Follow Up:

  Under the supervision of the Insurance Billing Manager, this position is responsible for the timely and accurate billing and follow-up of unpaid Medicare inpatient and outpatient accounts. This includes identification and processing of appropriate write-offs, accurate resolution of all credit balances and prompt response to help letters. Meet and exceed the minimum productivity volume, and standards of work as defined within the departmental policies and procedures.

  Patient Account Representative Commercial Insurance Follow Up, Patient Account Representative -(Quality Review/Vendor Liaison non-Certified):

  Under the supervision of the Commercial Supervisor, this position is responsible for the timely and accurate follow up of Commercial and Government HMO insurance Accounts Receivable, submitting appeals, and reporting issues. The Patient Account Representative will interpret contracts to calculate expected reimbursement, identifying additionally reimbursed contract carve outs, and submit appropriate contractual adjustments and write-offs. The position will have minimum productivity volume and standards of work to meet as defined within the departmental policies and procedures.

  Patient Account Representative - Medicare COB, MSP:

  This position under the supervision of the Government Billing Manager, this position is responsible for the timely and accurate follow-up of unpaid Medicare inpatient and outpatient accounts for issues related to coordination of benefits or Medicare as secondary, or primary related denials. This includes identification and processing of appropriate MSP guidelines, follow up with patient, employers and health insurance carriers for coordination of benefits, accurate and timely resolution of outstanding COB, MSP related issues. Meet and exceed the minimum productivity volume, and standards of work as defined within the departmental policies and procedures.

  Patient Account Representative Non-Certified-Cashier:

  Under the supervision of the Collection/Customer Service Manager, this position is responsible for assisting patients with making payment arrangements, mailing out charity applications and reviewing bank deposits for the hospital cashiering department. Complies to AB774 and all applicable federal and state laws and regulations.

  Patient Account Representative Commercial Insurance Biller Non-Certified:

  Under the supervision of the Billing Manager, this position is responsible for the timely and accurate billing of commercial and group insurance inpatient and outpatient accounts. This includes the pre-billing, billing and electronic submission of hospital claims; identification and processing of appropriate write-offs, accurate use of HMO matrix to identify responsible payer, identification of stop loss claims and “carve out” items that are reimbursed at different rates. Ensures compliance to the payer’s contracted billing requirements. Performs timely billing of commercial or group secondary insurance. Coordinates with the Medicare and Medi-Cal team for any MSP issues, HMO acknowledgements or Medicare/Medi-Cal as secondary billing. Meet and exceed the minimum productivity volume, and standards of work as defined within the departmental policies and procedures.

  Patient Account Representative Commercial Insurance Follow Up Non-Certified on-call:

  Under the supervision of the Insurance Billing Manager, this position is responsible for the timely and accurate follow up of Commercial and Government HMO insurance Accounts Receivable. This consists of contacting the appropriate responsible payer for the status of submitted claim(s) and resolution of delays in payment or underpayments of the contracted amount due to Presbyterian Intercommunity Hospital for its services rendered. Responsible for interpreting contracts to calculate expected reimbursement, identifying additionally reimbursed contract carve outs, and submitting appropriate contractual adjustments and write-offs.

  Commercial Tracer and Medical Records Representative Non-Certified:

  Under the supervision of the EOB, Refund Manager, this position is responsible for the timely and accurate review and status of claims submitted to payers within a time frame of 30-60 days following initial billing. This consists of confirming with payers receipt of claims, ensuring timely processing, detection and trending of payer payment delays, and determining the appropriate protocols needed to resolve existing account balances for expedited resolution of the contracted amount due Presbyterian Intercommunity Hospital for its services rendered. Responsible for identification and processing of appropriate write-offs, accurate use of HMO matrix to identify responsible payer, use of the contracts to determine accurate expected reimbursement. This role is responsible for the overall Medical Record process which includes: submitting requests to Health Information Management department, ensuring that records are logged and forwarded to requestor.

  Patient Account Representative EOB Review Non-Certified:

  Under the supervision of the EOB, Refund Manager , this position is responsible for the timely and accurate review of commercial and group insurance inpatient and outpatient payor correspondence, EOB’s. This consists of reviewing the received payer correspondence for the accurate payment of the contracted amount due Presbyterian Intercommunity Hospital for its services rendered. Responsible for identification and processing of appropriate write-offs, accurate use of HMO matrix to identify responsible payer, use of the contract data base to determine accurate expected reimbursement and the identification of stop loss claims and “carve out” items reimbursed that are reimbursed at different rates. Monitors payors to identify underpayment trends/issues and notifies management. Forwards correspondence, as necessary, to appropriate patient account representative for additional review, if needed. Initiates appeals of claims for inappropriate denials or underpayments. Reviews correspondence no later than three business days from receipt.

  Patient Account Representative Medi-Cal Biller/Follow up Non-Certified:

  Under the supervision of the Patient Accounting Director, this position is responsible for the timely and accurate billing through resolution of Medi-Cal inpatient and outpatient accounts. This includes billing, collection and follow-up activities; identification and processing of appropriate write-offs, accurate resolution of all credit balances and prompt response to communications from Medi-Cal. Ensures compliance to Medi-Cal billing requirements to include all coding edits. Performs timely billing of Medi-Cal as a secondary insurance to Medicare Part B and Commercial Insurance. Meet and exceed the minimum productivity volume, and standards of work as defined within the departmental policies and procedures.

  Patient Account Representative Medicare Biller:

  Under the supervision of the Billing Manager, this position is responsible for the timely and accurate billing of Medicare inpatient and outpatient accounts. Understands and complies to CMS billing requirements to include all coding edits. Performs timely billing of secondary insurance and follow up on unpaid balances due from secondary payers. Meet and exceed the minimum productivity volume, and standards of work as defined within the departmental policies and procedures.

  Refunds Processing Representative Non-certified:

  Under the supervision of the EOB, Refund Manager this position reviews, investigates and resolves all assigned credit balance accounts in accordance to all federal, state and contractual mandates. The refunds are completed in a timely and accurate manner. Identifies and reports to departmental management of issues that result in credit balances. Submits corrective adjustments to ensure credit balances are resolved.

  Patient Account Representative Customer Service Non-certified:

  Under the supervision of the Collections/Customer Service Manager, review unpaid hospital claims for patient accounts and use procedural guidelines to reduce the outstanding dollars on accounts receivable. Ensure incoming correspondence and inbound telephone calls are reviewed and answered in a timely manner. Accurately determine patient status, insurance coverage and billing information. Review accounts for write off to bad debt. Receive and update patient information.

  PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Hospital - Whittier, PIH Health Hospital - Downey and PIH Health Good Samaritan Hospital, 27 outpatient medical locations, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, women’s health, urgent care and emergency services. The organization is recognized by Watson Health as one of the nation’s Top Hospitals, and College of Healthcare Information Management Executives (CHIME) as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. PIH Health is certified as a Great Place to Work TM. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.

• About the company

  PIH Health Hospital - Downey is a non-profit community-based hospital located in Downey, California.

Notice