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PRIMARY FUNCTION: Posts payments and makes necessary adjustments via payment management systems as well as identifies and processes the issuance of patient or insurance refunds
ESSENTIAL FUNCTIONS OF THE JOB: (This list may not include all of the duties that may be assigned.)
1. Ensures payments or adjustments are posted in accordance with EOB’s and patient checks. Reviews and correct any errors until payments are balanced.
2. Post insurance payments and patient refunds from EOB or ERA accurately against appropriate line-item services, and enters adjustments as indicated when required according to contract.
3. Assesses, identifies payment/denial trends via payment management systems and communicates to Team Leader and Manager
4. Monitor and report any underpayment or overpayments.
5. Research and resolves any unapplied payments.
6. Performs other duties as assigned.
Adhere to all organizational and departmental policies and procedures including information security and confidentiality policies. Protects all sensitive information including but not limited to ePHI and PHI in accordance with organizational policy, Federal, State, and local regulations. 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.
TYPICAL WORKING CONDITIONS:
Lift/Carry 10 lbs. or less
Push/Pull 12 lbs. or less
Other Physical Requirements:
Sense of Sound
Sense of Touch
Ability to wear Personal Protective Equipment (PPE) as needed
EDUCATION: High school diploma/GED or equivalent.
EXPERIENCE: Minimum of one year of revenue cycle management experience required; three years preferred
KNOWLEDGE, SKILLS & ABILITIES:
• Knowledge of Medical billing and collection protocol, all types of insurance (HMO, PPO, POS, Medicaid etc.)
• Skill in defining problems, collection of data, interpreting billing information.
• Ability to communicate effectively verbally and written
• Ability to multi-task in a fast paced environment
• Ability to prioritize work
• Ability to work in a team environment or independently
The expected hourly range for this position located in Laguna Niguel, CA is $16.48 to $27.47. It is not typical for offers to be made at or near the top of the range. Pediatric Associates offers are based on several factors including but not limited to the candidate’s education, work experience, and certifications, all of which are dependent on the requirements of the specific role. In addition to base salary, the Pediatrics Associates Family of Companies and it’s affiliates offers a comprehensive benefits package, potential incentive and recognition programs, and retirement planning (all benefits are subject to eligibility requirements based on position, and division).