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.
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.