At Steward Health Care System, we are committed to improving the health of our communities by delivering exceptional, personalized behavioral health care with dignity, compassion, and respect. Our continued focus on the patient experience informs our caregivers in how to provide care that is respectful of and responsive to individual patient and family preferences, needs and values.
We dedicate ourselves in the communities we serve to delivering affordable health care to all and being responsible partners. No matter what your role, as a member of the Steward family, you are a specialist in the making every patient and family feel right at home, every co-worker a key to our success, and every referring practice, a team of prized colleagues.
In support of this, we commit ourselves to the following values:
If you are seeking a fast-paced, challenging position in an organization committed to achieving and maintaining a standard of excellence in all we do, our organization may be a good fit for you.
Performs prior authorization and billing functions.
• Provides superior customer service to internal and external clients, customers, and patients as referenced in the Service Excellence Standards.
• Ensures that patients are appropriately registered. Corrects problematic registrations through admitting and/or billing areas. Requests assistance of clinicians and coordinator as needed.
• Ensures that services are pre-authorized as required by payers.
• Obtains pre-authorizations/approvals for outpatient and inpatient services as needed.
• Confirms ongoing authorization for treatment and obtains continuing authorization. If clinician involvement is required, informs clinician of necessary actions they must take.
• Enters charges electronically.
• Assures the final diagnoses and operative procedures as stated by the physician are valid and complete with the guidance of the system edits and reports.
• Obtains any necessary clarification of information on the notes and charts.
• Prepares the appropriate claims documents required by each insurer.
• Submits, organizes, and tracks all insurance claims filed by the health care provider.
• Follows up until payment is received and manages collections activities when necessary.
• In addition to administrative duties, required to perform a variety of customer service functions. These often include answering patient questions on billing and handling collections if a patient fails to meet his or her financial obligations.
• Maintains communication between clients, families, and internal departmental personnel to ensure exchange of information related to billing.
• Participates in ongoing improvement of billing and charge capture standards and procedures.
• Performs all charge follow-up such as edits, submission of supporting documents, and correction of codes, incorrect insurance, or incorrect demographics.
• Identifies denial patterns.
• Works in several billing and collections systems to reduce or correct denials.
• Collects copayments and outstanding balances.
• Utilizes all insurance verification systems.
• Orders all medical supplies and office supplies.
• Supports cross coverage for the front desk.
• Performs other duties as assigned to support departmental needs.
REQUIRED KNOWLEDGE & SKILLS:
• Strong customer-service skills.
• Solid communication and interpersonal skills; ability to communicate with tact, courtesy, professionalism, and full understanding of HIPAA guidelines.
• Advanced knowledge of medical codes
• Advanced knowledge of medical terminology, abbreviations, techniques, and surgical procedures.
• Must possess strong organizing and prioritizing skills.
• Ability to return to tasks and follow up on issues requiring multiple interventions.
• Ability to work independently and handle multiple priorities within a high pressure environment.
• Duties are high complex, varied, require planning and coordinating several activities at one time, and demand the use of problem-solving skills and analysis of circumstances to develop appropriate actions.
I. Education: High School Diploma
II. Experience: 2+ years of previous billing experience required. Experience working with obtaining prior authorizations and troubleshooting with patients regarding approvals and denials with insurance companies.
III. Certification/License: Billing and coding certificate preferred.
IV. Software/Hardware: Computer software competencies (MSWord suite, ability to quickly learn scheduling and charge entry systems).
Important COVID message
Please note, St. Elizabeth's Medical Center is taking additional, necessary preparations to ensure patients can receive compassionate care in a safe, carefully managed environment - with confidence and without fear. Our Safe and Ready program consists of a rigorous [five-point] standard ensuring patient safety, confidence, and convenience: Expanded hours will allow previously cancelled procedures to be scheduled as quickly as possible. Any COVID-19 related care takes place in designated areas away from other patients and their families. Emergency Departments are reorganized to be a safe place to treat all emergency patients. A stringent cleaning policy has been implemented throughout the hospital. A strictly controlled visitor and masking policy is required for patient safety. You can rest assured that we have made the necessary preparations to provide care in a safe, controlled, and professional way.