The Patient Account Representative is responsible for performing clerical duties related to revenue cycle activities involving Kaua’i Region accounts. This includes submitting clean and accurate claims to third-party payors, following up on outstanding and aged claims, investigating claim denials and problem accounts, and communicating with guarantors. This role ensures accurate and timely invoicing, payment processing, accounting reconciliation, and compliance with company policies. The work schedule may include weekends, holidays, and/or evenings, and may require travel to various facilities within the region as necessary.

I.

A. Accounts Receivable 60%

1. Posts administrative/write-off adjustments as identified and approved by Revenue Cycle Management. Answers inquiries related to accounts via telephone, written correspondence/email, or in person.

2. Interviews patients and/or responsible parties to obtain financial information that determines their ability to pay in cases of delinquency or eligibility for charity care.

3. Conducts daily follow-up on aged accounts to identify claim statuses and the need for resubmission with appropriate attachments.

4. Notifies the Patient Financial Services Manager (PFSM) of claim rejections resulting from incorrect registration processes, such as insurance verifications, referrals, authorizations, and incomplete required registration forms.

5. Offers Charity Care applications to uninsured or underinsured patients.

6. Monitors installment plans or payment arrangements for timeliness and consistency, contacting guarantors who are delinquent in making payments or fulfilling promises.

7. Re-files claims with payors if claims remain unsettled within 30 days from the date of the initial claim.

8. Determines the collectability of accounts approaching the over 120 days aging category.

9. Reviews specific aged trial balance reports to identify uncollectible accounts.

10. Sends out monthly statements with appropriate notices when necessary.

11. Plans and coordinates the work schedule for sending out monthly statements.

12. Answers phone calls regarding billing inquiries and maintains good public relations by tactfully clarifying misunderstandings that arise in financial matters.

B. Delinquent and Bad Debt Accounts 20%

1. Reviews aged accounts to validate Medicaid coverage before presenting them to the PFSM for further action.

2. Prepares documentation as necessary for legal proceedings.

3. Retrieves accounts that have been written off or canceled when reinstatement becomes necessary.

4. Prepares requests for review by the PFSM to adjust accounts when necessary.

C. Credit Balances Accounts 10%

1. Reviews the credit balance report daily and ensures that refund requests for payers or guarantors are submitted to the PFSM by the end of each month for all bona fide credit balances.

2. Refers unsolvable credit balances to the PFSM for final disposition prior to the month's close.

D. Investigation of Problem Accounts 5%

1. Receives, investigates, resolves, and reports complaints and questions related to monthly hospital statements.

2. Identifies issues impeding the collectibility of accounts, from the quality of registration data to inappropriate billing information.

3. Discusses the nature of complaints or questions with appropriate staff and reviews the history of events leading to the hospital charges.

4. Documents, updates, and corrects all communication regarding account history in the billing system.

5. Requests information from appropriate staff needed for the refiling of claims as necessary.

E. Additional Responsibilities 5%

1. Considers patients’ needs when serving or assisting them.

2. Assists patients to departments rendering services as needed.

3. Plans and organizes workload while remaining flexible to the acute needs of the section.

4. Assists in the orientation and training of new employees within the department as assigned.

5. Supports the manager and team members as needed; adapts positively to changes; supports the organization's mission, vision, and values; maintains a cooperative attitude; provides suggestions for workflow improvements; and communicates any issues promptly and effectively to the manager or designee.

6. Ensures compliance with the Health Insurance Portability and Accountability Act (HIPAA) regulations and upholds the highest standards of confidentiality for all facility, employee, and patient information.

7. Fosters and maintains effective communication, exemplifying exceptional customer service, promoting teamwork, collaborating professionally, and supporting positive interactions with patients, visitors, providers, staff, and the community.

8. Follows, applies, and upholds the policies and procedures of The Joint Commission (TJC), Kaua’i Region, HHSC, as well as federal, state, and other regulatory agencies, concerning residents/patients, employees, providers, and visitors.

9. Provides assistance during emergencies, participates in disaster drills, and engages in committee meetings and training sessions.

10. Complies promptly with all mandatory in-service requirements and actively participates in relevant educational and training programs. Engages in staff development and is dedicated to enhancing knowledge and skills while sharing acquired insights with colleagues.

11. Maintains compliance with all safety, infection control, and employee health requirements.

12. Reports incidents and unusual occurrences promptly in accordance with departmental policies.

13. Performs other related duties as assigned.

Pay: From $3,900.00 per month

Benefits:

• Dental insurance
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Application Question(s):

• Do you live in Kauai Hawaii?

Experience:

• Office: 2 years (Preferred)
• Medical billing: 1 year (Preferred)

Work Location: In person