Under the supervision of the Commercial/Managed Medi-Cal follow-up Manager, this position is responsible for the timely and accurate billing through resolution of Medi-Cal/Managed MediCal inpatient and outpatient accounts. This includes billing, collection and follow-up activities; identification and processing of appropriate write-offs, accurate resolution of all credit balances and prompt response to communications from Medi-Cal/Managed Medi-Cal Health Plans. Ensures compliance to Medi-Cal billing requirements to include all coding edits. Performs timely billing of Medi-Cal as a secondary insurance to Medicare Part B and Commercial Insurance. Meet and exceed the minimum productivity volume, and standards of work as defined within the departmental policies and procedures.

PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 37 outpatient medical office buildings, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women’s health, urgent care and emergency services. The organization is nationally recognized for excellence in patient care and patient experience, and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.

Required Skills

• Demonstrated ability to use a 10-key adding machine, calculator, fax machine, photocopy machine keyboard for data entry and personal computer (PC)
• Ability to perform multiple tasks, good mathematical skills, sound decision-making abilities and good verbal and written communication skills
• Ability to learn new systems, become proficient in development of reports via hospital systems and tools provided
• Proficient in Excel and Word Document for appeal submission to payers

Required Experience

Required:

• High School Diploma
• Minimum two years in hospital Medi-Cal and Medi-Cal Manage Care billing and follow up
• Knowledge of Medi-Cal billing requirements and regulations

Preferred:

• Associate degree
• Evidence of continuing education
• Familiarity with commercial third-party billing requirements. Allscripts/SFM, NThrive/Claims Manager

• Demonstrated ability to use a 10-key adding machine, calculator, fax machine, photocopy machine keyboard for data entry and personal computer (PC)
• Ability to perform multiple tasks, good mathematical skills, sound decision-making abilities and good verbal and written communication skills
• Ability to learn new systems, become proficient in development of reports via hospital systems and tools provided
• Proficient in Excel and Word Document for appeal submission to payers