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Patient Account Representative-PD/Days
MemorialCare Saddleback Medical Center
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Patient Account Representative-PD/Days

MemorialCare Saddleback Medical Center

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Details
Posted:
June 3, 2019
Location:
Laguna Hills, California
Salary:
Type:
Part Time - Experienced
Discipline:
Admin / Clerical

Essential Functions and Responsibilities of the Job

  • Ability to submit Medicare, Commercial, and private pay claims in a timely fashion
  • Demonstrates ability to precisely review and calculate all Medi-Cal, Medicare, Cal-optima and managed care payments to ensure accurate reimbursement
  • Demonstrates ability to research and/or follow up on insurance refunds to ensure accurate account balances
  • Monitors, Pays, Updates all Invoices from different vendors. Document appropriately in the Hospice/Health system all correspondences and other transactions in interacting with Accounts Payable and Vendors
  • Ability to complete end-of the month closing and statistical reports
  • Demonstrates ability to monitor and analyze Accounts Receivable (A/R) to ensure minimal number of days in A/R
  • Ability to verify insurance coverage for all payer types for patient admissions. Makes written and or verbal inquires to third party payer to verify insurance benefits, eligibility and insurance status
  • Obtains and tracks all authorizations for home health and hospice patients
  • Ability to be at work and be on time
  • Ability to follow company policies, procedures and directives
  • Ability to interact in a positive and constructive manner
  • Ability to prioritize and multitask

Essential Job Outcomes

  • Reviews and identifies all Medicare, Medi-Cal, Cal-Optima and managed care payments accurately on a daily basis
  • Calculates Medicare, Medi-Cal, Cal-optima, and Managed care adjustments accurately and in a timely manner
  • Assess denied services and apply contract knowledge to determine proper preventive measures
  • Identifies insurance refunds accurately and sends Inquiries to insurance company in a timely manner
  • Accurately documents telephone calls in MCHPS system and answers Correspondence in a timely manner
  • Process and pay all invoices in a timely manner while effectively interacts with A/P staff to keep records and up to date
  • Complete end-of-month closing and statistical reports and ensure that charges and payments are balanced and Process additional development requests (ADRs)
  • Bill Medicare, Medi-Cal and all private payers in a timely manner while maintaining low Accounts Receivable days
  • Verifies insurance for all Payers types, for all homecare and hospice admissions and documents in EMR
  • Obtain and track all necessary Pre- certification and pre-authorization from all payer types and document in EMR
  • Functions as a liaison between insurance case manager, clinician and the clinical supervisor
  • Ensure timely, accurately filing of All NOEs in to DDE within timely filing assigned by CMS
  • Ability to be at work and be on time and follow company policies, procedures and directives
  • Ability prioritize and multitask while maintaining a positive and constructive manner
  • Other duties as assigned

Internal Number: SAD002111
About MemorialCare Saddleback Medical Center
Let us introduce ourselves. We're MemorialCare, a nonprofit health system that includes four hospitals, two medical groups, imaging centers, surgical centers and much more. As one of the leading health systems in Orange County and Los Angeles County, we're confident that no matter what your needs are, we have the teams, tools and know-how to support you every step of the way.
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