SUMMARY OF POSITION:

The Patient Account Specialist I interprets EOBs for correct payment verification, adjustments, and denials. The Patient Account Specialist I is also responsible for handling outstanding claims on aging reports and resolving patient inquiries regarding billing statements and insurance overage-related matters. The Patient Account Specialist I has to maintain up-to-date knowledge about CPT, ICD-10 CM, billing regulations, and payers' requirements. The Patient Account Specialist I has to comply with HIPAA guidelines and maintain confidentiality regarding patient account status and the organization's financial affairs.

ESSENTIAL JOB FUNCTIONS:

• Reviews, edits, processes, and submits electronic and hardcopy claims to various payers (Medicare, Medicaid, Managed Care, and Private Insurance) for FQHC (Federally Qualified Health Centers) and FFS (Fee-For-Service) reimbursement, ensuring accuracy of payment entries and completeness of charge capture information.
• Maintains up-to-date knowledge of medical billing requirements for FQHC Medi-Cal, Medicare, state, local programs, and private insurance payers.
• Reports issues or payment trends (e.g., charges applied to the wrong visit, incorrect billing codes) to the supervisor for resolution.
• Edits charge/claim details and corrects submission errors to ensure accuracy.
• Researches and resolves outstanding claims on aging reports to minimize delays in reimbursement.
• Responds to payer requests and remittance advices promptly and professionally, including phone calls, letter responses, appeals, and submission of medical records or additional information as required.
• Under the guidance of the Patient Account Specialist II, addresses patient inquiries and billing complaints by making necessary adjustments, exploring all options to secure claim payments, referring complex issues to appropriate staff, and ensuring proper follow-up.
• Posts charges and submits claims for NEMS physicians’ hospital visits.
• Provides training and support to the Billing Department and front desk staff in Member Services, Medical, Dental, Optometry, Laboratory, and Radiology Departments.
• Adheres to policies and procedures for billing records retention.
• Acts as a liaison between physicians, insurance companies, and third-party organizations by processing and verifying invoices, ensuring claim reimbursements, and auditing patient accounts.
• Performs additional duties as assigned by management.

• Completion of an AA/AS degree is required, and a 4-year university diploma is preferred or maybe substituted with a minimum of 3 years of work experience in healthcare.
• Working experience in a healthcare or FQHC setting is preferred
• Working experience with Epic PB Resolute is preferred
• Familiar with Medicare, Medicaid, Private insurances, Managed Care (HMO & PPO), CPT, and ICD-10 CM
• Must have excellent analytical and communication skills
• Must be proficient in computer skills
• Ability to write business correspondence
• Strong organizational skills to coordinate multiple, varied billing processes simultaneously
• Upholds high customer service standards in a demanding and complex health care organization
• Demonstrates initiative, resourcefulness, integrity and dedication to timeliness to achieve high customer satisfaction levels
Self-motivated, diligent, organized, resourceful, responsible, and enthusiastic

LANGUAGE:

• Proficient in written and spoken English and Chinese (Cantonese and/or Mandarin)
Fluent in other languages is an asset

STATUS:

• This is an FLSA Non-exempt position.
• This is not an OSHA high-risk position.
This is a Full Time position.

NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).