Ensures every patient account is financially secured in accordance with departmental guidelines for all SSM facilities. Under general supervision works to coordinate the needs of the patients with other departments and the requirements of the third party payers. Estimates, communicates and collects patient financial responsibility; educating the patient of financial programs and opportunities.
Communicates effectively and professionally with patients, visitors, physicians, and coworkers.
Interacts with others in a positive, respectful, and considerate manner.
Uses facility resources appropriately and avoids wasteful practices.
Participates in continuing education and other learning experience
Shares knowledge gained in continuing education with staff.
Verifies all commercial insurance coverage, workers' compensation insurance, accident insurance, and state and government programs and determines patient's financial responsibility if applicable.
Obtains precertification number from physician's office if applicable.
Initiates precertification for many of our SSM physicians, by obtaining clinical information and contacting insurance company
Determines patient qualification for coverage by third-party payer and informs financial counselor, patient, or family member of status.
Maintains current list of facility insurance contracts and payment schedules.
Documents prequalification for third-party payer before date of scheduled admission.
Pre-registers patients by obtaining their demographic information and request any financial responsibility from the patient.
Maintains a current working knowledge of Governmental Rules and Regulations, utilizing this knowledge in decision making and work initiative thus assuring compliance, avoiding regulatory violations that can result in monetary and/or civil penalties to the employee and SSM Health Care.
Documents information accurately and timely on appropriate accounts in both payer fields and notes fields.
Updates all insurance plans requirements and changes, for all states and have the ability to interpret contract language.
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 issues/opportunities with third party payer's, and provide feedback to direct manager for implementation of process improvement, as evidenced by quality audits and completed process improvement action items.
Maintains a consistent level of productivity and quality standards set by the department.
Works through denials, to determine reason and eliminate future denials.
Understands and has the ability to interpret physician orders, CPT and ICD 9 codes in order to obtain authorizations.
High School Diploma or Equivalency required
Some college preferred
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