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Patient Account Representative, Hospice Outpatient- PD/Days

MemorialCare Health System Laguna Hills, CA

Employment Type

: Full-Time

Industry

: Miscellaneous


Job Responsibilities* 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 multitaskJob Functions:* 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* Perform other duties as assigned

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