Patient Account Specialist I
Company: North East Medical Services
Location: Daly City
Posted on: April 1, 2026
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Job Description:
Description SUMMARY OF POSITION: The Patient Account Specialist
I interprets EOBs for correct payment verification, adjustments,
and denials. The Patient Account Specialist I is also responsible
for handling outstanding claims on aging reports and resolving
patient inquiries regarding billing statements and insurance
overage-related matters. The Patient Account Specialist I has to
maintain up-to-date knowledge about CPT, ICD-10 CM, billing
regulations, and payers' requirements. The Patient Account
Specialist I has to comply with HIPAA guidelines and maintain
confidentiality regarding patient account status and the
organization's financial affairs. ESSENTIAL JOB FUNCTIONS: Reviews,
edits, processes, and submits electronic and hardcopy claims to
various payers (Medicare, Medicaid, Managed Care, and Private
Insurance) for FQHC (Federally Qualified Health Centers) and FFS
(Fee-For-Service) reimbursement, ensuring accuracy of payment
entries and completeness of charge capture information. Maintains
up-to-date knowledge of medical billing requirements for FQHC
Medi-Cal, Medicare, state, local programs, and private insurance
payers. Reports issues or payment trends (e.g., charges applied to
the wrong visit, incorrect billing codes) to the supervisor for
resolution. Edits charge/claim details and corrects submission
errors to ensure accuracy. Researches and resolves outstanding
claims on aging reports to minimize delays in reimbursement.
Responds to payer requests and remittance advices promptly and
professionally, including phone calls, letter responses, appeals,
and submission of medical records or additional information as
required. Under the guidance of the Patient Account Specialist II ,
addresses patient inquiries and billing complaints by making
necessary adjustments, exploring all options to secure claim
payments, referring complex issues to appropriate staff, and
ensuring proper follow-up. Posts charges and submits claims for
NEMS physicians’ hospital visits . Provides training and support to
the Billing Department and front desk staff in Member Services,
Medical, Dental, Optometry, Laboratory, and Radiology Departments.
Adheres to policies and procedures for billing records retention .
Acts as a liaison between physicians, insurance companies, and
third-party organizations by processing and verifying invoices,
ensuring claim reimbursements, and auditing patient accounts.
Performs additional duties as assigned by management.
Qualifications Completion of an AA/AS degree is required, and a
4-year university diploma is preferred or maybe substituted with a
minimum of 3 years of work experience in healthcare. Working
experience in a healthcare or FQHC setting is preferred Working
experience with Epic PB Resolute is preferred Familiar with
Medicare, Medicaid, Private insurances, Managed Care (HMO & PPO),
CPT, and ICD-10 CM Must have excellent analytical and communication
skills Must be proficient in computer skills Ability to write
business correspondence Strong organizational skills to coordinate
multiple, varied billing processes simultaneously Upholds high
customer service standards in a demanding and complex health care
organization Demonstrates initiative, resourcefulness, integrity
and dedication to timeliness to achieve high customer satisfaction
levels Self-motivated, diligent, organized, resourceful,
responsible, and enthusiastic LANGUAGE: Proficient in written and
spoken English and Chinese (Cantonese and/or Mandarin) Fluent in
other languages is an asset STATUS: This is an FLSA Non-exempt
position. This is not an OSHA high-risk position. This is a Full
Time position. NEMS is proud to be an Equal Opportunity Employer
welcoming diversity in our workforce. Pursuant to the San Francisco
Fair Chance Ordinance, we will consider for employment qualified
applicants with arrest and conviction records. NEMS BENEFITS:
Competitive benefits, including free medical, dental and vision
insurance for employee, spouse and/or children; and company
contribution to 401(k).
Keywords: North East Medical Services, Redwood City , Patient Account Specialist I, Accounting, Auditing , Daly City, California
