Medi-Cal/Medicaid Patient Account Representative

This position can sit in either Truckee, CA or Reno, NV.

Responsible for submitting accurate claims, ensuring timely reimbursement from various third-party payers and patients, and confirming proper documentation occurs in the facilities' billing system. Collaborates with Revenue Cycle departments and third-party payers on efforts related to follow-up, denials, and appeals.

Duties include handling all Medi-Cal/Medicaid and Managed Medicaid plan billing and follow up, examining denied and underpaid claims to determine reasons, communicating directly with payers to follow up on outstanding claims, resolving payment variances, and achieving timely reimbursement.

Provides payers with specific reasons for suspected underpayments and reviews denial reasons given by payers, documenting patient account status and expected payment amounts.

Works with management to identify root causes of denials and helps develop strategies for reducing Accounts Receivables (A/R).

Maintains understanding of federal and state regulations, payer requirements, and explanations of benefits to identify and report billing compliance issues.

Keeps current on payer bulletins, coding and billing training and manuals.

Responsible for knowledge of updated Medi-Cal and Medicaid policies and billing specifics and communication to relevant departments.

Maintains accurate payer files and documents all interactions thoroughly.

Handles payer-specific communications and participates in quality improvement efforts aiming to exceed productivity goals.

Demonstrates initiative by gathering information about issues and documenting recommendations for system fixes.

Understands and complies with HIPAA guidelines when handling patient information.

Performs other duties as assigned and adheres to system policies and procedures.