Patient Account Specialist – Hospital Billing Governmental Services

This is a Full Time (80 hours every pay period) benefited position, Monday-Friday from 9AM-5:30PM. Over time additional hours when needed.

Join the Scripps Health team and work alongside passionate caregivers and provide patient-centered healthcare. Receive endless appreciation while you build a rewarding career with one of the most respected healthcare organizations nationwide.

Why join Scripps Health?

AWARD-WINNING WORKPLACE:

• #5 in Fortune Best Workplaces in Health Care 2023
• #78 in 2023 PEOPLE Companies that Care
• #95 in Fortune 100 Best Companies to Work for 2023
• Recognized by Newsweek as one of America's Greatest Workplaces for Diversity in 2024
• Nearly a quarter of our employees have been with Scripps Health for over 10 years.

As a Patient Account Specialist, you will be supporting the Billing Services department at our 4S Ranch Business Services location. This role is essential in managing a high volume of hospital Government Insurance/Billing documents, while also performing follow up actions to gather accurate information needed from patients, payers and providers. The ideal candidate is one who thrives in a fast-paced environment and has a passion for insurance and medical claims. As a Patient Account Specialist, you will be responsible for the following:

• Responsible for working aged reports and credit balances on a regular basis set by department guidelines.
• Follows-up with insurance carriers timely on unpaid claims until claims are paid or only self-pay balance remains. Does not have claims written off for timely filing.
• Processes rejections by either making accounts self-pay and generating a letter of rejection to patient or correct any billing error and resubmitting claims to insurance carriers.
• Keeps updated on all billing requirements and changes for all insurance types.
• Responsible for responding to all inquiries, billing denials, other correspondence and phone requests in an efficient, timely, and effective manner. Secures needed medical documentation required or requested by insurances.
• Works with HIM staff to ensure that complete diagnosis/procedure codes and modifiers are reported to insurance carriers as required.
• Working directly with the insurance company, healthcare provider, liable third parties, and patient to get a claim processed and paid
• Works to help maintain Accounts Receivable (AR) days at or near target level set by the Hospital Senior Team.
• Supporting continuous improvement of organization processes and personal knowledge and skills, and maintaining and protecting confidential information
• Providing excellent customer service through cooperative working relationships, and meeting productivity and quality standards.

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Required Education/Experience/Specialized Skills:

• Strong working knowledge of managed care plans, insurance carriers, government Payers and payer requirements.
• Knowledge of Medical Terminology and Medicare Compliance.
• Familiarity with HIPAA privacy requirements for patient information.
• Basic understanding of DRG's, Medical ICD9/ICD10 codes and CPT/HCPC Codes.
• Ability to multitask and stay organized.
• Good verbal and written communication skills.
• Detail oriented and ability to prioritize work.
• Requires a moderate level of interpersonal, problem solving, and analytic skills.
• Knowledgeable on insurance and reimbursement process.
• Ability to establish/maintain cooperative working relationships with staff, Medical Staff and providers.

Preferred Education/Experience/Specialized Skills:

• Two years of patient accounts experience in a healthcare setting.
• Working knowledge of healthcare EPIC software preferred.
• Minimum two year experience billing Medicare, Medicaid, Blue Cross and Commercial insurance preferred, three or more years desired.
• Knowledge in Excel, Word and basic computer functions such as saving documents, sharing documents
• Demonstrate strong computer skills required. (Education may be substituted for experience in some areas.)
• Demonstrate knowledge of accounts receivable practices, payer billing and reimbursement procedures and practices.
• Working knowledge of hospital UB04, CPT-4, HCPCS, ICD-10 and Revenue codes.
• Proficient in institutional insurance billing guidelines using 837I X12 Version 005010X279A1 transactions.