In collaboration with the Manager of Front Office Functions Reception & Practice Management, this position will assist in managing all functions related to County Programs such as Healthy Way Los Angeles (HWLA) and other assigned/specific programs. He/she will do so by developing and implementing quality, cost-effective, efficient systems and protocols for standardizing processes across all AltaMed Health Services sites.
Responsible for maintaining thorough knowledge on all program requirements, updates, as well as maintains and develops processes for accurate program enrollments.
Prepares, develops and maintains the programs updates and requirements to improve processes and operational/financial protocols.
Assist, plan and implement, and train front on office policies and procedures; includes operational protocols and Revenue Cycle Coordination program requirements for current and new front office services and Patient Financial Services as applicable.
Monitors quality and compliance with all front office standards including the development of audits for Electronic Practice Management (E.P.M.) and Electronic Health Record (E.H.R.), documentation and facility audits, as it relates to the program requirements.
Prepares, develops and maintains the programs updates and requirements to improve processes and protocols for the Electronic Health Record (E.H.R.) documentation for providers, as it relates to program requirements.
Prepares, develops and performs quarterly site audits to ensure all sites are in compliance with policies and procedures and program requirements.
Develop processes to ensure a cost effective pharmacy strategies as well as accurate and timely collection of reimbursement.
Responsible for timely Accounts Receivable, billings and collections including multiple facilities and complex programs.
Prepare and submit accurate, timely and complete claims and patient statements for assigned accounts.
10. Identify credits, adjustments and write-offs, providing documentation for approval by management.
11. Review and resolve payment denials and claim rejections; research explanation of benefits and re-submit within 48 hours of receipt.
12. For outstanding claims identified through Aging reports, research and re-submit overdue claims/statements within established timeframes.
13. Respond to customer inquiries regarding account status; resolving discrepancies,, setting up payment schedules and preparing adjustments and refunds.
14. Review and analyze individual accounts receivable and research discrepancies.
15. Responsible for training and monitoring Healthy Way Los Angeles (HWLA) Enrollment Coordinator staff, productivity, quality as well as knowledge of program requirements and overall performance.
16. Perform all other related duties as assigned.
Skills and Abilities:
1. Detail oriented, thorough and the ability to motivate.
2. Excellent oral and written communication and presentation skills.
3. Computer literacy required.
4. Ability to handle multiple tasks and projects.
5. Good interpersonal skills for all interactions.
6. Self-motivated and action-oriented.
7. Highly professional demeanor internally and externally with outside sources.
8. Knowledge of health insurances, benefits, and basic ICD-9 and CPT coding.
9. Knowledge of HIPAA Guidelines including the PHI privacy requirements.
High school Diploma required coupled with a minimum of two years of claims management billing experience required.
A minimum of two years of front office practice supervisory experience and experience utilizing electronic health records preferred.
CPR/First Aid certificate preferred.
Bilingual English/Spanish preferred.
We promote a comprehensive continuum of care, assisting individuals and their families from birth through the senior years, regardless of...