Patient Accounting Representative

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.

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.
• Audits 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.
• Documents 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 :

Additional Requirements :

Preferred Qualifications :

Location : Wailuku, Hawaii