Demo

Patient Accounting Representative

Kaiser Permanente
Kaiser Permanente Salary
Wailuku, HI Other
POSTED ON 3/28/2025
AVAILABLE BEFORE 5/28/2025
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.

Qualifications:

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:


  • 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.

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