About The Wilshire Group

The Wilshire Group is a boutique consulting firm in Los Angeles, California. Our firm focuses on revenue cycle optimization as well as bringing a strong leadership team as the voice between operations and IT. Our team has worked with over 100 healthcare systems across the US.

Our Values

• To be professional | To be efficient | To be flexible

This position offers $25.00 per hour.

The Patient Account Specialist will focus on the review and resolution of Accounts Receivable. They will review account information and remittance advice forms to verify proper reimbursement and follow up on the resolution of accounts. Processing and follow-up with third-party collections. Verifying that records for patients include all information required for Third Party reimbursement. Handling hospital billing and collections, denials and appeals, and checking claim status. Processing hospital billing and follow-up. Consult with claims processors at Third Party Payer companies regarding disputes/denied claims and follow up on all bills not processed within allowed claim period.

Position Duties And Responsibilities

• Responsible for all aspects of account follow up and collections, including processing appeals
• Reviews explanation of benefits (EOBs) to ensure proper reimbursement of claims and reports any problems, issues, or payer trends
• Ability to analyze accounts and determine next appropriate action for account resolution
• Ability to identify, resolve and escalate trends to ensure timely payment
• Collaborates with management to reduce aging of accounts by providing verbal and written communication
• Works with payers to determine reasons for denials, corrects and reprocesses claims for reimbursement in a timely manner
• Accurately and thoroughly documents the pertinent collection activities in appropriate system
• Maintains HIPPA patient confidentiality standards for medical and financial information

Desired Professional Skills And Experience

• High school or GED preferred
• Three years hospital billing and collections experience required
• In-depth knowledge of Medicare, Medicaid, commercial payer reimbursement policies and procedures
• Excellent communication and problem-solving skills
• Ability to work in a collaborative, team environment
• Ability to be well-organized, detail-oriented, in a fast-paced environment
• Ability to think critically and identify the global impact across the revenue cycle with a solution oriented approach
• Epic and or Invision experience