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.
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.
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 SSM Health - System Office:
SSM Health 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, SSM Health 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.
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 fa...mily 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