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.
- 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.
