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 & Federal regulation and payer guidelines. Also resolves denials and does reimbursement analysis to ensure maximum reimbursement was received according to payer contractual agreements.

• Performs 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.
• Expedites larger dollar accounts to ensure revenue optimization for prompt payment.
• Follows up timely on payment with insurance companies, agencies, payers and/or patients ; researches and takes 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.
• Responds to patient and insurance inquiries promptly and courteously.
• Performs audits as needed for quality control and to ensure efficient follow up.
• Collects monies owing for all services rendered, including third party payers, employers, and guarantors.
• Document all actions into account notes.
• Resolves payer denials, including submission of appeals as needed.
• Communicates timely and appropriately with Team Lead/Supervisor to identify and resolve payer/claim submission issues.
• Analyzes and takes appropriate action steps according to MHS protocols.
• Strives to achieve targeted benchmarks and exceed collection goals for prompt account resolution.

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

• High school diploma.

• N/A

• 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.

• One (1) year experience medical insurance claims processing, demonstrating knowledge of Medicaid, Medicare, & 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.