Job Description

Steward Health Care System LLC ("Steward") is a fully integrated, physician-led national health care services organization committed to providing the highest quality of care in the most cost-efficient manner in the communities where our patients live. Steward - the largest privately held health care company in the U.S. - owns and operates 35 community hospitals across nine states, serves over 1,000 distinct communities and employs approximately 40,000 health care professionals. In addition to our hospitals, the Steward provider network includes 4,800 providers, 25 urgent care centers, 87 preferred skilled nursing facilities, substantial behavioral health offerings, over 7,300 hospital beds under management, and approximately 1.5 million full risk covered lives through the company's managed care and health insurance services.

Steward Medical Group (SMG), Inc. is Steward's multi-specialty group practice with over 4,500 employees including over 1,800 physicians and advanced practitioners. SMG operates approximately 450 practice locations throughout Massachusetts, Southern New Hampshire, Rhode Island, New Jersey, Pennsylvania, Ohio, Florida, Utah, Arizona, Texas, Louisiana and Arkansas, and provides more than 4 million patient encounters per year.

Under the direction of the Manager and Supervisor of Reimbursement & Patient Account Services, Specialist is responsible for resolution of patient account balances associated with insurance denials, answer incoming insurance and practice calls with the ability to explain charges, services and insurance billing questions. Work with practices and payers to resolve claim denials and comply with insurance and SMG procedures, guidelines and policies.

• Various aspects of medical billing; claim creation, claim submission, payment posting for insurance and patient balances. These denials and appeals are billed in the AthenaNet system electronically. The AR Specialist must also obtain supporting documentation, i.e., medical records, EOB’s Remits, Authorizations, referrals, etc., from through our email applications, scanning system, Medicare remittance system, and Meditech (hospital billing system). The AR Specialist will review, interpret and apply contractual terms. Identify and/or apply contractual and administrative adjustments.
• Monitor insurance denials by running reports and contacting insurance companies to resolve and recover denied claims.
• Monitor aging reports for timely follow-up on unpaid claims.
• Knowledge of payer authorization guidelines in an effort to determine if appeal requires a clinical review or can be handled from a technical perspective.
• Knowledge of Third party payer and government guidelines.
• Retroactive review of registration data to aid in the assurance of clean claim submittal.
• Accurately document claim actions taken within patient account / claims.
• Ability to navigate and toggle back and forth within multiple payer websites and internal billing systems to determine various aspects of account detail necessary for data management.
• Assist in orientation and training of new staff, including work flow and system training.
• Serve as a resource for problem solving issues related to registration, demographic and insurance errors.
• Work payer correspondence including support tickets, emails and phone messages from internal and external contacts.
• Work collaboratively with Coding, Provider Enrollment and Cash Posting team as well as coworkers, Team Leads, Managers and practice staff to resolve claim and account issues.
• Assist Patient Accounts Team as needed with incoming and outgoing patient calls to resolve and collect on a patient statement.
• Adhere to the HIPAA guidelines regarding confidentiality relating to the release of financial and medical information.
• Additional duties as assigned by Manager

• Customer / Patient Account Services Skills
• Associates Degree in Business, Accounting or Finance preferred.
• 1-3 years experience and/or knowledge of insurance denials process
• 1-3 years health care claims processing, and follow-up background
• Successfully drives results while balancing multiple priorities and tasks
• Ability to keyboard at 35 words per minute
• Ability to diagnose and troubleshoot problems Ability to perform mathematical calculations
• Must have knowledge of ICD-9 and CPT-4 coding
• Strong knowledge on third party payors guidelines and procedures particularly
• Attention to detail.
• Possess strong verbal and written communication skills
• Possess strong analytical skills and computer skills; including Outlook, Excel and Word.

Application Instructions

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