Patient Account Assistant

This patient account assistant is responsible for administering complex payable functions as related to Medicare risk contracts, commercial capitation. This position is also expected to calculate and submit reinsurance claims by merging multiple systems data downloads into spreadsheets and employing complex pricing methodology to value all internal and external capitated claims on an as needed basis. This position will be responsible to pull queries and reports from claims databases for Managed Care Contracting, General Ledger and other management as needed.

• Verify authorization in IDX, with health care provider, complete benefit determination, process complex claims with manual calculations using current National Drug Codes and Average Wholesale Pricing in IDX system, at a maximum of 8 claims per hour with less than 1% errors
• Research and answer telephone inquiries from providers and members 
• Prepare monthly and quarterly compliance reports for claims timeliness and provider disputes
• Report any non-compliant issues with regards to C.I.A. guidelines to management prior to processing
• Process all voids and replacement claims. Enter all refunds to IDX. Handle all refund checks for the department

Required

• Three years of clerical experience in medical claims adjudication or Equivalent combination of education and experience 

Preferred

• Associates in Applied science in medical billing and claims adjudication or equivalent, upon hire

Dignity Health, one of the nation’s largest health care systems, is a 22-state network of more than 9,000 physicians, 63,000 employees, and 400 care centers, including hospitals, urgent and occupational care, imaging and surgery centers, home health, and primary care clinics. Headquartered in San Francisco, Dignity Health is dedicated to providing compassionate, high-quality, and affordable patient-centered care with special attention to the poor and underserved. For more information, please visit our website at www.dignityhealth.org. You can also follow us on Twitter and Facebook.

One Community. One Mission. One California 

Depending on the position offered, CommonSpirit Health offers a generous benefit package, including but not limited to medical, prescription drug, dental, vision plans, life insurance, paid time off (full-time benefit eligible team members may receive a minimum of 14 paid time off days, including holidays annually), tuition reimbursement, retirement plan benefit(s) including, but not limited to, 401(k), 403(b), and other defined benefits offerings, as may be amended from time to time. For more information, please visit our Total Rewards

Unless directed by a Collective Bargaining Agreement, applications for this position will be considered on a rolling basis. CommonSpirit Health cannot anticipate the date by which a successful candidate may be identified.