Patient Account Assistant

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 

As our Principal Patient Account Assistant, you will administer complex payable functions for Medicare risk contracts and commercial capitation.

Every day you will calculate and submit reinsurance claims by merging data from multiple systems and applying complex pricing methods to value capitated claims, and pull queries and reports from claims databases for Managed Care Contracting, General Ledger, and management.

To be successful in this role, you will bring capitation and claims expertise, advanced spreadsheet and database skills, and analytical precision.

• 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
• Research and answer telephone inquiries from providers and members 
• Prepare monthly and quarterly compliance reports for claims timeliness and provider disputes accurately 
• Report any non-compliant issues with regards to C.I.A. guidelines to management prior to processing. Assists manager with special projects.
• Process all voids and replacement claims. Enter all refunds to IDX. Handle all refund checks for the department. Maintain tracking spreadsheet for checks run and Financial Reporting. Verify whether refunds and voids have been updated to "Paid" status prior to submitting spreadsheet to Financial Reporting monthly.

Required

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

Preferred

• Associates Other Applied science in medical billing and claims adjudication or equivalent