Under general supervision and following established policies and procedures, supports the financial portion of the patient care experience through collaboration with other department, coordination of the needs of the patients, scheduling of appointments, accurate and timely verification of insurance eligibility and benefits, obtaining pre-certification, and registration. Estimates, communicates, and collects patient financial responsibility, educating the patient of financial programs/opportunities and timely follow up. Ensures compliance of payer regulations and actively works open denial reports to ensure appropriate and timely payment.
Enhances the overall patient care experience by minimizing wait times through efficient work processes and communication of delays, proactively meeting the patient needs, and utilizing the available tools and resources, as evidenced by patient satisfaction scores and leadership observations.
Enhances effective operations of the department through participation in a minimum of 50% of department meetings, reads and initials minutes for meetings not attended, participation in process improvement activities to achieve goals as evidenced by attendance record and completed process improvement action items.
Secures appropriate payment for services provided by the organization through verification of eligibility and specific benefits for procedures and services; coordination with physician office staff and third party payers to ensure precertification and notification requirements are met; accurate estimation, communication and collection of financial responsibility and/or financial programs to patients; ensuring timely follow up; and maintaining a consistent level of productivity avoiding levels of extremely high and very low productivity, as evidenced by the lack of denials, quality audits, key performance indictors and point of service collections.
Demonstrates streamlined processes to maintain safety and quality through accurate patient identification, validates/updates Master Patient Index (MPI) according to departmental policy, protects personal health information, and accurately interprets physician orders, as evidenced by quality audits and reviews.
Collaborates with departments and co-workers to enhance physician and patient satisfaction by utilizing available technologies to streamline verification and financial processes, reduce redundancy of information requested and monitor insurance verification issue/opportunities with third party payers, and provide feedback to direct manager for implementation of process improvement, as evidenced by quality audits and completed process improvement action items.
Timely scheduling, pre-registration and registration of patient appointments as evidenced by quality audits and satisfaction surveys.
Actively works denial report for open denials. Researches missing information and accurate insurance coverage and corrects accounts.
Identifies opportunities for improvement and communicates them to leadership.
High School or Equivalent (GED)
Three years of medical office experience. Knowledge of ICD-9/ICD-10 and CPT coding, insurance precertification, insurance claims, and patient registration.
SSM Health St. Joseph Hospital – St. Charles –
SSM Health St. Joseph Hospital - St. Charles is a 433-bed hospital offering highly-specialized care for critically ill patients. The hospital excels in many areas, including open-heart surgery, cardiac catheterizations, trauma and emergency services, sleep medicine, obstetrics, surgical services, oncology, vascular surgery, orthopedics and gastroenterology.
Internal Number: 17015915
About SSM Health
You’ve known us as many names throughout St. Louis, and now, we’re bringing our hospitals, doctors, home care and other services together under one name – SSM Health. With seven hospitals, 350+ physicians, more than 40 physician locations and 12,000 employees, we are part of something bigger and better. We’re connected to a wealth of resources, expertise and advance technology to help you, your family and our community live long, healthy lives.
We’ve grown and changed a lot over our 143-year history. Our name may be changing but our mission remains the same