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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 multitask Job 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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