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.

Essential Responsibilities:

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.

Basic Qualifications:

Experience

Minimum one (1) year collections or administrative experience.

Education

High school diploma.

License, Certification, Registration

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:

Minimum one (1) year experience medical insurance claims processing, demonstrating knowledge of Medicaid, Medicare, & Commercial payer requirements.
Post high school coursework in accounting.
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.

Patient Accounting Representative

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