Job Description

Eligibility Clerk

Sacramento PMA · Sacramento PMA Revenue Cycle Management
Sacramento, CA
Finance/Insurance/Reimbursement
Full Time, Days
Weekly Schedule: Monday - Friday 8:15am to 5:15pm
Bilingual: Preferred
Bilingual Type: English/Spanish
Posted 09/28/2021
Req # 6890

PRIMARY FUNCTION:  Eligibility Clerk is responsible for managing and monitoring all tasks and communication related to the intake of information from guarantors and/or delinquent accounts to insure account information accuracy and solicit payment Other duties include: keeping records of collections and status of accounts, and taking incoming and make outbound calls to assist with patient accounts.

REPORTS TO: Reports to the Practice Manager

ESSENTIAL FUNCTIONS OF THE JOB: (This list may not include all of the duties that may be assigned.)

  1. Monitor queue to ensure calls are being handled professionally and appropriately.
  2. Perform analysis, research, and making decisions to appropriately handle phone inquiries.
  3. Occasionally fill in for medical receptionist.
  4. Review acute charts (including recall, confirming addresses/phone numbers, insurance cards and coverage, etc.)
  5. Review well charts (including recall, confirming addresses/phone numbers, in5urance cards and coverage, etc.)
  6. Contact parents/patients to inform them of missing insurance information, balance and any other issues with insurance or account.
  7. Contact insurance companies to handle any issues (such as: adding newborns/new patients, etc.).
  8. Assist parents with adding newborns/new patients.
  9. Review and confirm coverage for all Medi-Cal patients charts for the upcoming month.
  10. Confirm and add remarks in electronic file.
  11. Updating addresses/phone numbers in all appropriate categories.
  12. Demonstrate good judgement and reads and abides by the company’s code of conduct, ethics, employee handbook, policies and procedures and other corporate mandates.
  13. Accountable for limiting the use and disclosure of Protected Health
  14. Information (PHI) for patients and employee’s information to the minimum necessary to perform the job.
  15. Other various duties as assigned, including cross training in other functional areas.

 

*Non patient-facing

 

PERFORMANCE REQUIREMENTS:

Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI in accordance with organizational policy, Federal, State, and local regulations.

 

TYPICAL WORKING CONDITIONS:

Indoor Work

Operating Computer

Reach Outward

Manual Dexterity

Lift/Carry 10 lbs. or less

Sitting

 

Other Physical Requirements:

Vision

Sense of Sound

Sense of Touch

 

EDUCATION: High School Diploma or equivalent required.

 

LICENSURE/CERTIFICATION: None

 

EXPERIENCE: Minimum 1 year of customer service experience in a healthcare setting required.

KNOWLEDGE, SKILLS & ABILITIES:

  • Knowledge of billing and collection policies and procedures, all types of insurance (HMO, PPO, POS, Medi-Cal etc.) Skill in defining problems, interpreting billing information.
  • Ability to multi-task in a face paced environment while meeting established production and quality goals/metrics.
  • Strong organizational skills, with ability to effectively prioritize work and daily basis and follow up on open items in a timely manner.
  • Must have strong verbal, written, and interpersonal communication skills
  • Demonstrates ability to work well in a team environment.
  • General PC knowledge including Microsoft Office, Internet and Email.

Beginning October 15, 2021, all new hires must demonstrate they are fully vaccinated for Covid-19 by their first day of employment.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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