Medi-Cal/Medicaid Patient Account Representative

Responsible for submitting accurate claims, ensuring timely reimbursement from third-party payers and patients, and confirming proper documentation in the facility's billing system. Works collaboratively with Revenue Cycle departments and third-party payers on follow-up, denials, and appeals.

Essential Duties and Responsibilities

• Manage all Medi-Cal/Medicaid and Managed Medicaid plan billing and follow-up.
• Examine denied and underpaid claims to determine reasons for discrepancies.
• Communicate directly with payers by phone and web portals to follow up on outstanding claims, resolve payment variances, and secure timely reimbursement.
• Provide payers with specific reasons for suspected underpayments and review denial reasons.
• Document patient account status and expected payment amounts.
• Work with management to identify, trend, and address root causes of denials and reduce accounts receivable.
• Maintain knowledge of federal and state regulations, payer requirements, and explanations of benefits to identify billing compliance issues and payer discrepancies.
• Stay current with payer bulletins, coding, and billing training materials.
• Know updated Medi-Cal and Medicaid policies and billing specifics and communicate relevant updates to PFS Management, Registration, and Coding teams.
• Maintain accurate files for each payer, including contact names, addresses, phone numbers, and other pertinent information.
• Document all interactions with payers thoroughly.
• Handle payer-specific communications from payers and internal business office departments.
• Participate in ongoing quality improvement efforts and meet productivity goals.
• Gather information and examples related to issues and help document recommendations for system fixes.
• Communicate trends and issues to management and help monitor and validate fixes.
• Maintain compliance with HIPAA guidelines when handling patient information.
• Perform other duties as assigned.