*This is a Full Time (80 hours every pay period) benefited position, Monday-Friday from 9AM-5:30PM. Over time additional hours when needed. * Join the Scripps Health team and work alongside passionate caregivers and provide patient-centered healthcare. Receive endless appreciation while you build a rewarding career with one of the most respected healthcare organizations nationwide. *Why join Scripps Health?* /AWARD-WINNING WORKPLACE:/ * #5 in Fortune Best Workplaces in Health Care 2023 * #78 in 2023 PEOPLE Companies that Care * #95 in Fortune 100 Best Companies to Work for 2023 * Recognized by Newsweek as one of America’s Greatest Workplaces for Diversity in 2024 * Nearly a quarter of our employees have been with Scripps Health for over 10 years. As a Patient Account Specialist, you will be supporting the Billing Services department at our 4S Ranch Business Services location. This role is essential in managing a high volume of hospital Government Insurance/Billing documents, while also performing follow up actions to gather accurate information needed from patients, payers and providers. The ideal candidate is one who thrives in a fast-paced environment and has a passion for insurance and medical claims. As a Patient Account Specialist, you will be responsible for the following: * Responsible for working aged reports and credit balances on a regular basis set by department guidelines. * Follows-up with insurance carriers timely on unpaid claims until claims are paid or only self-pay balance remains. Does not have claims written off for timely filing. * Processes rejections by either making accounts self-pay and generating a letter of rejection to patient or correct any billing error and resubmitting claims to insurance carriers. * Keeps updated on all billing requirements and changes for all insurance types. * Responsible for responding to all inquiries, billing denials, other correspondence and phone requests in an efficient, timely, and effective manner. Secures needed medical documentation required or requested by insurances. * Works with HIM staff to ensure that complete diagnosis/procedure codes and modifiers are reported to insurance carriers as required. * Working directly with the insurance company, healthcare provider, liable third parties, and patient to get a claim processed and paid * Works to help maintain Accounts Receivable (AR) days at or near target level set by the Hospital Senior Team. * Supporting continuous improvement of organization processes and personal knowledge and skills, and maintaining and protecting confidential information * Providing excellent customer service through cooperative working relationships, and meeting productivity and quality standards. #LI-JS1 *Required Education/Experience/Specialized Skills:* * Strong working knowledge of managed care plans, insurance carriers, government Payers and payer requirements. * Knowledge of Medical Terminology and Medicare Compliance. * Familiarity with HIPAA privacy requirements for patient information. * Basic understanding of DRG's, Medical ICD9/ICD10 codes and CPT/HCPC Codes. * Ability to multitask and stay organized. * Good verbal and written communication skills. * Detail oriented and ability to prioritize work. * Requires a moderate level of interpersonal, problem solving, and analytic skills. * Knowledgeable on insurance and reimbursement process. * Ability to establish/maintain cooperative working relationships with staff, Medical Staff and providers. *Preferred Education/Experience/Specialized Skills:* * Two years of patient accounts experience in a healthcare setting. * Working knowledge of healthcare EPIC software preferred. * Minimum two year experience billing Medicare, Medicaid, Blue Cross and Commercial insurance preferred, three or more years desired. * Knowledge in Excel, Word and basic computer functions such as saving documents, sharing documents * Demonstrate strong computer skills required. (Education may be substituted for experience in some areas.) * Demonstrate knowledge of accounts receivable practices, payer billing and reimbursement procedures and practices. * Working knowledge of hospital UB04, CPT-4, HCPCS, ICD-10 and Revenue codes. * Proficient in institutional insurance billing guidelines using 837I X12 Version 005010X279A1 transactions. **Job:** **Business Office* **Organization:** **Scripps Health Corp* **Title:** *Patient Account Specialist* **Location:** *Central San Diego County-SAN DIEGO-SCRIPPS CORPORATE OFFICES* **Requisition ID:** *242006932*