PATIENT ACCOUNT SPECIALIST I

The Patient Account Specialist I interprets EOBs for correct payment verification, adjustments, and denials. The Patient Account Specialist I is also responsible for handling outstanding claims on aging reports and resolving patient inquiries regarding billing statements and insurance overage-related matters. The Patient Account Specialist I has to maintain up-to-date knowledge about CPT, ICD-10 CM, billing regulations, and payers' requirements. The Patient Account Specialist I has to comply with HIPAA guidelines and maintain confidentiality regarding patient account status and the organization's financial affairs.

ESSENTIAL JOB FUNCTIONS:

- Reviews, edits, processes, and submits electronic and hardcopy claims to various payers (Medicare, Medicaid, Managed Care, and Private Insurance) for FQHC (Federally Qualified Health Centers) and FFS (Fee-For-Service) reimbursement, ensuring accuracy of payment entries and completeness of charge capture information.

- Maintains up-to-date knowledge of medical billing requirements for FQHC Medi-Cal, Medicare, state, local programs, and private insurance payers.

- Reports issues or payment trends (e.g., charges applied to the wrong visit, incorrect billing codes) to the supervisor for resolution.

- Edits charge/claim details and corrects submission errors to ensure accuracy.

- Researches and resolves outstanding claims on aging reports to minimize delays in reimbursement.

- Responds to payer requests and remittance advices promptly and professionally, including phone calls, letter responses, appeals, and submission of medical records or additional information as required.

- Under the guidance of the Patient Account Specialist II , addresses patient inquiries and billing complaints by making necessary adjustments, exploring all options to secure claim payments, referring complex issues to appropriate staff, and ensuring proper follow-up.

- Posts charges and submits claims for NEMS physicians hospital visits .

- Provides training and support to the Billing Department and front desk staff in Member Services, Medical, Dental, Optometry, Laboratory, and Radiology Departments.

- Adheres to policies and procedures for billing records retention .

- Acts as a liaison between physicians, insurance companies, and third-party organizations by processing and verifying invoices, ensuring claim reimbursements, and auditing patient accounts.

- Performs additional duties as assigned by management.

Qualifications

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- Completion of an AA/AS degree is required, and a 4-year university diploma is preferred or maybe substituted with a minimum of 3 years of work experience in healthcare.

- Working experience in a healthcare or FQHC setting is preferred

- Working experience with Epic PB Resolute is preferred

- Familiar with Medicare, Medicaid, Private insurances, Managed Care (HMO & PPO), CPT, and ICD-10 CM

- Must have excellent analytical and communication skills

- Must be proficient in computer skills

- Ability to write business correspondence

- Strong organizational skills to coordinate multiple, varied billing processes simultaneously

- Upholds high customer service standards in a demanding and complex health care organization

- Demonstrates initiative, resourcefulness, integrity and dedication to timeliness to achieve high customer satisfaction levels

- Self-motivated, diligent, organized, resourceful, responsible, and enthusiastic

LANGUAGE:

- Proficient in written and spoken English and Chinese (Cantonese and/or Mandarin)

- Fluent in other languages is an asset

STATUS:

- This is an FLSA Non-exempt position.

- This is not an OSHA high-risk position.

- This is a Full Time position.

NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).