At NorthBay Health, the Patient Account Representative III Ambulatory is responsible for timely and accurate billing, follow-up, and collection of ambulatory patient accounts. The role manages accounts across NorthBay Ambulatory practices using standard billing practices and regulatory requirements.
Primary responsibilities include:
- Following up on accounts with practices, carriers, and/or patients until balances are resolved through payments and adjustments per NorthBay guidelines and contracts.
- Managing account populations to ensure AR aging meets or exceeds established goals.
- Processing initial claims in a timely manner, including claims edited through the billing scrubber.
- Handling carrier denials promptly to maximize cash benefit.
- Assisting with backlogs as needed.
- Supporting periodic reassignment of account workload to address priority areas.
- Providing responsive and professional customer service by phone and in writing.
- Communicating clearly, handling conflict diplomatically, and resolving inquiries in a timely manner.
Requirements & Qualifications
Education
- High school graduate or equivalent preferred.
- College coursework with emphasis in Business preferred.
Experience
- 3 to 5 years of recent professional fee billing and collections experience, preferably in a multi-specialty practice environment.
- Familiarity with CPT-4, HCPCS, and ICD-10 coding.
- Proficiency with Medicare, Medi-Cal, and Commercial insurance plans, including HMO and PPO.
- Experience with UB-04 and/or HCFA 1500 claim forms.
- Experience resolving account follow-up for both electronic and manual claims.
- Strong investigative, analytical, and problem-solving skills.
- Demonstrated teamwork, productivity, and quality performance.
Skills
- Ability to quickly learn computer programs related to claims processing.
- Understanding of payor contracts and fee schedules.
- Knowledge of Knox-Keene regulations and managed care concepts.
- Ability to prioritize work and process accounts quickly to meet deadlines.
- Ability to process claims accurately and on time.
- Independent judgment and effective problem-solving ability.
- Knowledge of medical terminology.
- Ability to adapt to changing priorities and perform multiple task types daily.
- Proficiency with personal computers, public folders, shared drives, internet use, and spreadsheet/word processing tools.
Interpersonal Skills
- Ability to communicate effectively and professionally with members, providers, payors, and internal staff.
- Team-oriented with a willingness to collaborate across departments.
Benefits & Perks
NorthBay Health offers a comprehensive benefits package, which may include:
- Medical, dental, and vision insurance
- Life, disability, and long-term care coverage
- Paid time off, including vacation, sick leave, holidays, and bereavement
- 403(b) retirement plan with employer match
- Education reimbursement for eligible roles
- Professional development and training programs
- Employee Assistance Program
- Wellness programs
- Recognition programs
- Shift differentials
- Market-based compensation reviews and increases subject to approval and organizational performance
Location
California, US
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
Yes
Posted
3 months ago