San Ysidro Health Center - San Diego, CA
posted about 2 months ago
The Call Processing Reimbursement Specialist I is a vital role within San Ysidro Health, responsible for managing the complete revenue cycle, which includes billing for medical, dental, and hospital claims. This position requires direct interaction with members over the phone, ensuring that all insurance balances are followed up on to guarantee accurate and timely reimbursement. The specialist will also handle self-pay collections after insurance and address any billing-related inquiries from patients. In this role, the specialist must demonstrate a thorough understanding of San Ysidro Health's services and programs to effectively assist callers. Responsibilities include reviewing and updating patient demographics, providing excellent customer service, and efficiently managing calls. The specialist will need to recognize and address unique medical issues, urgent services, and patient grievances, following established protocols for resolution or escalation to a supervisor. The position requires logging in to receive or make calls as per the schedule, utilizing break codes as defined by the call management system. The specialist will prepare accounts for billing accuracy, transmit claims using both automated systems and manual processes, and ensure that all necessary attachments are provided to third-party claims. Additionally, the role involves calculating disallowances and adjustments based on various reimbursement schedules and performing timely follow-ups on unpaid claims. The specialist must maintain assigned Accounts Receivable at or below the set goal consistently and compose professional correspondence with internal and external entities. The Call Processing Reimbursement Specialist I will also participate in meetings and training sessions as required and may be called upon to assist with special projects or audits, which could involve evening or weekend hours. Adherence to departmental policies, quality assurance programs, and safety standards is essential.