Back to search
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
- 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 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.
Learn more about this Employer on their Career Site
