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Patient Financial Services Billing Specialist

Company: Alameda Health System
Location: San Leandro
Posted on: June 8, 2021

Job Description:



The PFS Billing Specialist is responsible for all aspects reviewing charges for claims and performing third party billing activity for hospital services. Candidates will need to have a strong understanding of billing codes and guidelines for Medicare, Medi-Cal, and health insurance. In addition to having a strong knowledge in State and Federal rules and regulations. There are two openings available.


The following are the duties performed by employees in this classification. However, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification.

  • The PFS Billing Specialist is responsible for all aspects of billing primary, secondary, and tertiary payers for AHS facility claims including: Identifying issues or trending and provide suggestions for findings and claims activity performed. Review the account information and necessary system applications to determine the next appropriate work activity. Verify claims have passed edits utilizing appropriate resources and applications. Perform appropriate billing functions, including manual re-bills as well as electronic submission to payers. Edit claims to meet and satisfy billing compliance guidelines for electronic submission. Manage and maintain worklist inventory, complete reports, and resolve high priority and aged inventory.
  • Respond timely to emails and telephone messages as appropriate. Communicate issues to management, including payer, system, or escalated account issues.
  • Maintains information or operational records; screens reports for completeness and mathematical accuracy; list, abstracts, or summarizes data; compiles routine report from a variety of sources.
  • May, as a secondary responsibility, review notes, receipts, permits, licenses, etc; computes and receives fees when the amount is not in question or is readily obtainable from fixed schedules; posts data; keeps records, and prepares reports in accordance with pre-determined forms and procedures.
  • Prepares billing documents for collection of revenues from third party payer programs and patients; checks and verifies charge rates for services; reconciles patient account balances verifies payments.
  • Reviews billing documents to assure program compliance for Medicare, Medi-Cal, Mental Health, and insurance programs; assures that all appropriate medical documentation is included in the billing package.
  • Other duties as assigned.

Any combination of education and experience that would likely provide the required knowledge, skills, and abilities as well as possession of any required licenses or certifications is qualifying.


Required Education: High school diploma or equivalent education.

Minimum Experience: One year of experience in a Revenue Cycle area within the Alameda Health System; OR the equivalent of two years' experience, performing medical billing or medical accounts receivable functions in a healthcare insurance related environment

Keywords: Alameda Health System, San Leandro , Patient Financial Services Billing Specialist, Other , San Leandro, California

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