This position performs highly technical and specialized functions for the outpatient clinics. The employee works with billing, revenue cycle and accounting entities and team members to ensure billing and collections for outstanding patient accounts and account receivables is within the clinic budget targWith approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services. Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. For 25+ years, Prospect Medical has been focused on our mission of supporting independent physicians where, through risk arrangements, we work closely together with health plans, facilities and healthcare physicians for the benefit of every person who comes to us for care. We provide quality healthcare services that are designed to offer our patients highly coordinated, personalized care and that help them live healthier lives. Prospect Medical Systems manages highly successful IPAs by leveraging our best-practices, results-driven administrative services to manage patients under risk arrangements with health plans/CMS.Minimum Education: High School Diploma.
Minimum Experience: One to two (1-2) years of Clinic billing/collections experiences required. Understands and remains updated with current coding and billing regulations and compliance requirements. Good computer skills with demonstrated proficiency in Microsoft Office applications. Good computer skills with demonstrated proficiency in Microsoft Office applications. Detail oriented with good analytical and organizational skills.Comfortable in a fast-paced environment with the ability to multitask concurrent priorities in an organized manner.Good oral and written communication skills with the ability to communicate with all levels of management.Willingness to address issues and take ownership, knowing when and how to escalate issues.
Req. Certification/Licensure: Medical Billing certificates preferred
Routinely review and audit clinic billing/collections with the third party billing entities and clinic operations team to ensure timely billing and maximize collections according to insurance contracts, and proactively identify risks and problems impacting clinic cash flow.
Review, analyze and codes clinic diagnostic and procedural information that determines Medicare, MediCal, HMO, and Private insurance payments. Implement actions to improve billing/collections processes, charge capture and optimize reimbursement.
Monitor and log daily cash and check deposit (co- pay, checks, e -deposition) and upload/scan EFT deposits to the billing companies.
Document and track monthly Capitation, FFS and physician collection logs.
Post daily billing bathes/claim encounters and maintain internal control for timely billing and collections.
Assist in accounting team to complete monthly AP in a timely manner. Review, code and process AP Invoices, and maintain and reconcile daily petty cash logs.
Post daily billing batches/claim encounters and maintain internal control for timely billing and collections.
Workers Comp, including Invoice billing.
Urgent Care billing
Assist in accounting team to complete monthly AP in a timely manner. Review, code and process AP Invoices, and maintain and reconcile daily petty cash log.
Process patient payments and communicate such via email and/or through patient letters
Complete routine/weekly check run at Corporate when needed
Other Clinic operations administrative duties and projects assigned, such as cross covering Administrative assistance duties during absences and/or when needed.
Job Location: Open to remote
Routinely review and audit clinic billing/collections with the third party billing entities and clinic operations team to ensure timely billing and maximize collections according to insurance contracts, and proactively identify risks and problems impacting clinic cash flow.
Review, analyze and codes clinic diagnostic and procedural information that determines Medicare, MediCal, HMO, and Private insurance payments. Implement actions to improve billing/collections processes, charge capture and optimize reimbursement.
Monitor and log daily cash and check deposit (co- pay, checks, e -deposition) and upload/scan EFT deposits to the billing companies.
Document and track monthly Capitation, FFS and physician collection logs.
Post daily billing bathes/claim encounters and maintain internal control for timely billing and collections.
Assist in accounting team to complete monthly AP in a timely manner. Review, code and process AP Invoices, and maintain and reconcile daily petty cash logs.
Post daily billing batches/claim encounters and maintain internal control for timely billing and collections.
Workers Comp, including Invoice billing.
Urgent Care billing
Assist in accounting team to complete monthly AP in a timely manner. Review, code and process AP Invoices, and maintain and reconcile daily petty cash log.
Process patient payments and communicate such via email and/or through patient letters
Complete routine/weekly check run at Corporate when needed
Other Clinic operations administrative duties and projects assigned, such as cross covering Administrative assistance duties during absences and/or when needed.
