Patient Account Specialist

$50,731 - $67,600/Yr

Scripps Health - San Diego, CA

Full-time - Entry Level

San Diego, CA

1,001-5,000 employees

Hospitals

About the position

The Patient Account Specialist at Scripps Health plays a crucial role in the Billing Services department, managing a high volume of hospital Government Insurance/Billing documents. This full-time position requires effective follow-up actions to gather accurate information from patients, payers, and providers, ensuring timely processing of claims and maintaining accounts receivable standards. The ideal candidate thrives in a fast-paced environment and is passionate about insurance and medical claims, contributing to patient-centered healthcare.

Responsibilities

• Work aged reports and credit balances regularly as per department guidelines.
• Follow up with insurance carriers on unpaid claims until they are resolved or only self-pay balance remains.
• Process rejections by making accounts self-pay or correcting billing errors and resubmitting claims.
• Stay updated on all billing requirements and changes for various insurance types.
• Respond to inquiries, billing denials, and other correspondence in a timely manner.
• Secure necessary medical documentation required by insurances.
• Collaborate with HIM staff to ensure accurate diagnosis/procedure codes are reported to insurance carriers.
• Work with insurance companies, healthcare providers, and patients to process and pay claims.
• Help maintain Accounts Receivable (AR) days at or near target levels set by the Hospital Senior Team.
• Support continuous improvement of organizational processes and personal skills while maintaining confidentiality.
• Provide excellent customer service through cooperative working relationships.

Requirements

• Strong working knowledge of managed care plans, insurance carriers, and government payers.
• Knowledge of Medical Terminology and Medicare Compliance.
• Familiarity with HIPAA privacy requirements for patient information.
• Basic understanding of DRGs, Medical ICD9/ICD10 codes, and CPT/HCPC Codes.
• Ability to multitask and stay organized.
• Good verbal and written communication skills.
• Detail-oriented with the ability to prioritize work.
• Moderate level of interpersonal, problem-solving, and analytic skills.
• Knowledgeable about insurance and reimbursement processes.
• Ability to establish and maintain cooperative working relationships.

Nice-to-haves

• Two years of patient accounts experience in a healthcare setting.
• Working knowledge of healthcare EPIC software.
• Minimum two years experience billing Medicare, Medicaid, Blue Cross, and Commercial insurance preferred, three or more years desired.
• Knowledge in Excel, Word, and basic computer functions.
• Demonstrate knowledge of accounts receivable practices and payer billing procedures.
• Working knowledge of hospital UB04, CPT-4, HCPCS, ICD-10, and Revenue codes.
• Proficient in institutional insurance billing guidelines using 837I X12 transactions.

Benefits

• Full-time position with benefits
• Opportunity to work in an award-winning workplace
• Supportive work environment with a focus on patient-centered healthcare