St. Mary's Good Samaritan Senior Patient Account Representative in St. Louis, Missouri

Description

Role Purpose:

This position is responsible for training new and present staff for all account receivable activities as assigned. This may include claims processing, general follow up, denials resolution and/or credit balance resolution.

Additionally, the senior functions as a primary application super user, assisting staff with day to day operational inquiries, and management with workload assignment. The Senior Patient Account Rep, Tri-State CBO services all non-Wisconsin accounts.

Responsibilities:

  • Trains new staff on an ongoing basis regarding day to day functions and applications. Trains existing staff on new processes, payer updates, and assigned reporting. Functions as Super user for primary applications.
  • Coordinates with other CBO teams to escalate opportunities to reduce cycle time
  • Keeps supervisor informed of system malfunctions, problem areas, and other information that would hinder optimal performance. Escalates account issues as appropriate to Supervisor and or Manager in an effort to resolve account issues so that appropriate payment is received.
  • Attends and participates in weekly unit meeting and all other meetings when required.
  • Assists with workflows and reassignment of duties for projects, backlogs, and productivity.
  • Works daily accounts as assigned. Take all action necessary to resolve account issues and ensure accurate payment.
  • Analyzes and researches claim delays or payment discrepancies following up with payer, hospital department, and/or patient to resolve issues as needed.
  • Performs all appeals and denial recovery procedures needed to appropriately and accurately resolve denied claims.
  • Ensures that all activities related to CBO functions meet department requirements, maximize revenue collection, and achieve leading practice levels of performance.
  • Daily Focus on attaining productivity and quality standards recommending new approaches for enhancing performance and productivity when appropriate.
  • Manages work queues to department standards and performance expectations
  • Maintains appropriate account notation by making timely and accurate documentation in the corresponding patient business services system.
  • Participates in department audits as needed.
  • Initiates series of letters and phone calls to guarantor/patients to notify them of rejected claims by their insurance company or requesting them to contact their insurance company to resolve account issues.
  • Collaborates with other CBO teams to ensure prompt and accurate billing and rebilling of insurance claims or will fax claim to payers when requested. Obtain medical records information when requested from the insurance companies.
  • Understands all payer guidelines related to insurance follow up; be knowledgeable and proficient with payer websites and other useful resources pertaining to the insurance follow up function.
  • Daily focus on complying with policies, processes and department guidelines.
  • Works all reports, electronic or hardcopy, related to billing, such as but not limited to, Work Ques, hold reports, and EDI rejection reports to ensure claims are submitted timely and accurately, per department guidelines.
  • Processes claims for secondary insurance carriers, attaching all required documentation to ensure claims are filed to appropriate payers
  • Maintains and updates demographic and insurance information on accounts including contract information to ensure the accurate submission of claims.
  • Understands basic principles of coding, such as ICD9M, ICD10M, CPT and HCPCS, working with HIM or CRS to resolve claim coding issues.
  • Performs other related duties as directed that corresponds to overall functions of the position.
Qualifications

Minimum Requirements:

  • Completion of a secondary education and at least 1 year responsible comparable experience required

About Patient Business Services:

The Patient Business Services Division (PBS) of SSM Health is made up of over 1200 employees across four states (Missouri, Illinois, Oklahoma, and Wisconsin). PBS serves as the financial liaison between patients, hospitals, insurance companies, and other payers. We perform hospital revenue cycle functions for 19 facilities including scheduling, insurance verification, pre-registration, onsite registration, financial counseling, claims processing, cash applications, insurance follow-up/denials resolution, patient billing, and customer service.


Organization: SSM Health - System Office

Primary Location: Missouri-St. Louis-SSM Health System Office - 1145 Corporate Lake

Work Locations: SSM Health System Office - 1145 Corporate Lake (0033.3) 1145 Corporate Lake St. Louis, 63132

Job: Clerical & Customer Service

Req ID: 18005449