Job description
Job description
Pacific Health Group is at the forefront of revolutionizing health and wellness.
PHG is setting new benchmarks in healthcare services, leading with groundbreaking approaches and innovative solutions to empower our members, uplift families, and impact communities. Pacific Health Group's vibrant culture fuels passionate problem-solvers who thrive on collaboration to deliver unparalleled care.
Joining us means being part of a progressive movement championing personal and professional growth through industry expertise, advanced tech, and an appreciative community. Embark on this journey to transform lives and make a tangible difference.
Responsibilities:
- Case Management: Collaborate with case managers, social workers, patient coordinators, and other staff to ensure accurate and complete documentation of patient care plans, services rendered, and any changes in patient condition or level of care.
- Billing: Assign appropriate medical codes (such as ICD10, other) for diagnoses, treatments, and services provided in long-term care settings, prepare and submit claims to Medicaid for reimbursement, and create invoices and claims for member/patient interactions and outreaches.
- Consolidated Billing: Ensure compliance with consolidated billing requirements for health plans, which mandate that all services provided to members/patients are billed by the company.
- Denial Management: Analyze and appeal denied claims, gathering additional documentation or clarification from staff as needed.
- Accounts Receivable Management: Monitor and follow up on outstanding accounts receivable, working with payers and health plans to resolve issues and ensure timely reimbursement, including reconciliation of payers.
- Compliance: Stay up-to-date with constantly changing regulations, guidelines, and policies related to long-term care billing and reimbursement, and ensure the facility's billing practices are compliant.
- Training and Education: Provide training and guidance to facility staff on documentation requirements, coding practices, and billing procedures to ensure accurate and compliant billing (i.e. ICD10, other)
- Other: Perform other duties as assigned by management.
Join us and experience the rewards and security that come with being a part of our dedicated team!
Equal Employment Opportunity
Pacific Health Group, along with its divisions, is a proud Equal Opportunity Employer. We embrace diversity and are devoted to creating an inclusive environment for all employees. Our commitment is to ensure equal employment opportunities for every qualified candidate, irrespective of race, religion, gender, sexual orientation, gender identity, age, national origin, citizenship, disability, marital status, veteran status, or any other status protected by federal, state, or local laws.
At Pacific Health Group, we recognize the importance of accessibility and are dedicated to providing reasonable accommodations for individuals with disabilities. We believe that our strength lies in our diversity, and we are committed to building a workforce that reflects the varied communities we serve. Join us in a workplace where everyone's contributions are valued and respected.
Pre-Employment
Pacific Health Group is a drug-free workplace. Employment is contingent upon a successful pre-employment, post offer background check.
Expected schedule: Monday - Friday 8:30am - 5:00pm
