SSM HEALTH Patient Account Representative HBP in Saint Louis, Missouri
Description Role Purpose: This position is responsible for processing the professional 1500 component of all hospital accounts based on third party claims processing and payment rules and regulations. This includes insuring claims are billed in a compliant and timely manner and the resolution of both debit and credit insurance variances. The Hospital Provider Based Patient Account Rep services all non-Wisconsin accounts. Responsibilities: * Work assigned accounts daily for claim issues and/or payment variances debit/credit. Take all action necessary to resolve account issues and ensure accurate payment. * Process all professional 1500 claims for inpatient, outpatient, and recurring accounts for commercial and government payers whether through electronic or paper means in an accurate, compliant and timely manner. * Maintain knowledge base specific to professional 1500 billing and claim processing requirements for all payers through various training opportunities and the use of current reference tools and materials. * Understand basic principles of coding such a ICD9M, ICD10M, CPT and HCPCS. * Analyze and research payment variances following up with payer, hospital department, and/or patient to resolve discrepancies. * Process insurance refunds as needed when overpayments are identified on the professional 1500 claim. * Perform all appeals and denial recovery procedures needed to appropriately and accurately resolve denied professional 1500 claims. * Ensure that all activities related to follow up functions meet department requirements, maximize revenue collection, and achieve leading practice levels of performance. * Daily Focus on attaining productivity and quality standards and recommending new approaches for enhancing performance and productivity when appropriate. * Attend and participate in all unit meetings and all other meetings as requested. * Keep team leads/supervisor informed of systems malfunctions, problematic areas and other information that would hinder optimal performance. * Understand all payer guidelines related to professional 1500 claims processing and payment; be knowledgeable and proficient with payer websites and other useful resources pertaining to the claim resolution. * Performs other related duties as directed that corresponds to overall functions of the position. Qualifications Minimum Qualifications: * High School Diploma or Equivalent GED * At least 1 year of comparable experience required * Exceptional communications and customer service skills and attention to detail About Company - System Office: Company is one of the largest Catholic health systems in the country and is dedicated to quality and compassionate care for anyone in need, regardless of ability to pay. Based in St. Louis, where its System Office is located, Company operates 20 hospitals in Wisconsin, Illinois, Missouri and Oklahoma. We provide care in various settings: outpatient sites, physician offices, a pharmacy benefit company, an insurance plan, hospitals, nursing homes, home care, hospice, telehealth and a technology company.Our Mission: Through our exceptional health care services, we reveal the healing presence of God. Company complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex.Employer's Job# 18003723Please visit job URL for more information about this opening and to view EOE statement.