Patient Accounting Representative

Job Summary:

Patient Account Representatives perform billing and follow up for hospital or professional claims. This includes accurate and timely submission of claims and insurance follow up, according to State and Federal regulation and payer guidelines.

They also resolve denials and conduct reimbursement analysis to ensure maximum reimbursement is received according to payer contractual agreements.

Essential Responsibilities:

• Perform accurate and timely billing of insurance claims in accordance with policies and procedures of Maui Health and in compliance with State/Federal regulations, payer health plan guidelines, and third-party payer requirements.
• Expedite larger dollar accounts to ensure revenue optimization for prompt payment.
• Follow up timely on payment with insurance companies, agencies, payers, and/or patients; research and take action as required on outstanding accounts.
• Audit payments and appeals as needed to ensure Maui Health has received corrected, expected payment from payers in accordance with contract terms.
• Respond to patient and insurance inquiries promptly and courteously.
• Perform audits as needed for quality control and to ensure efficient follow up.
• Collect monies owing for all services rendered, including third-party payers, employers, and guarantors.
• Document all actions into account notes.
• Resolve payer denials, including submission of appeals as needed.
• Communicate timely and appropriately with Team Lead/Supervisor to identify and resolve payer/claim submission issues.
• Analyze and take appropriate action steps according to MHS protocols.
• Strive to achieve targeted benchmarks and exceed collection goals for prompt account resolution.

Basic Qualifications:

Experience:

• Minimum one (1) year collections or administrative experience.

Education:

• High school diploma.

License, Certification, Registration:

• N/A

Additional Requirements:

• Demonstrated ability to perform diversified clerical functions and basic accounting procedures.
• Demonstrated ability to motivate debtors to pay.
• Demonstrated knowledge of and skill in adaptability, change management, conflict resolution, customer service, influence, interpersonal relations, oral communication, problem solving, teamwork, and written communication.

Preferred Qualifications:

• One (1) year experience in medical insurance claims processing, demonstrating knowledge of Medicaid, Medicare, and Commercial payer requirements.
• An Associates Degree or Bachelors Degree in Business Administration, Finance, Accounting or Healthcare-related field may be substituted for one (1) year experience as a Patient Account Representative.
• Knowledge of medical terminology, CPT-4 and ICD-10-CM coding.
• 10-key by touch.
• Post high school coursework in accounting.