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.
To function as a member of the administrative team and complete all daily tasks to ensure smooth day to day operations in busy practice. Responsible for posting, coding, and collection of receivables.
- Receives and organizes hospital census, charge sheets and other billing data to be coded and entered for Professional Billing
- Contacts various parties to request and/or obtain missing documentation and appropriate coding.
- Reviews and ensures that correct information / documentation has been entered into the EHR and reviews the charges to ensure there entered correctly before they are billed
- Organizes, compiles and enters all assigned charges, balances to the system, maintains spreadsheets as needed and logs as applicable.
- Reviews all daily charges from the “interface” and corrects errors to ensure proper billing and demographic information’s.
- Works with HIM to receive monthly reports to Audit Hospital charge and report findings to manager monthly
- Provides coding feedback to the medical providers, Managers and staff regarding billing problems via e-mail.
- Attains proper documentation from the patient’s medical record and assures that all new or denied claims are corrected utilizing CPT-5and ICD-10 codes to insure proper reimbursement.
- Reviews, copies and appeals denials as outlined in the Explanation of Benefits.
- Audits patient accounts and generates claims for billing
- Audits patient accounts and responds to patient cases / emails to ensure that refunds and adjustments are properly done.
- Research and contact various parties to obtain information to submit corrected data for re-billing. Such as researching addresses from returned mail, contacting the patient for correct billing information, calling hospitals and other agencies for proper documentation, etc.
- Timely communicates, verbal or written, with payers, managers and staff to expedite collections.
- Handles “Billing Phone Calls” for all patient billing questions in a timely manner and works with PF Department in matters that need to be escalated.
- Contacts patient to inform them of coverage of services and outstanding balances and their responsibility prior to appointment date and works with staff and RPM to ensure they have proper training to do so as well.
- Work Holds and Denials and call insurance companies to verify insurance eligibility and coverage. Requests appropriate referrals when required by the insurance companies
- Identifies training needs and implements needed training and workflow adjustment alongside management and RPM
- Reviews Missing slips and provides physicians real time updates
- Works with offsite locations to audit and enter billing slips
- Complies with the facility privacy policies and procedures for the management of protected health information (PHI)
- Understands that ignoring situations where PHI may have been potentially compromised comes with legal ramifications to both the practice and myself.
- Utilizes appropriate Personal Protective Equipment in the performance of duties.
- Demonstrates knowledge of policies and procedures applicable to job position.
- Maintains computer skills, keeps up with coding and billing updates necessary to insure accuracy and efficiency in the performance of all assigned job duties.
- Adheres to infection control and safety policies, including education, reporting and practice implementation specific to job position.
- Helps to maintain the office area to reduce the risk of safety hazards and enhance general appearance.
- Protects and honors patient and co-worker confidentiality.
- Consistently adheres to Agency dress code.
- Work independently or as a “Team” and without direct supervision by prioritizing work and following through on duties.
- Meets attendance and punctuality expectations.
- Behavior toward coworkers, supervisors and patients consistently displays a courteous respectful attitude and promotes teamwork within the organization.
- Performs other duties as assigned by supervisor.
Required Knowledge and Skills
• Education from approved medical administrative program or equivalent
• High School Diploma or equivalent
• 1 to 3 years of experience as a Clinical Secretary/ Billing Specialist
• Experience with electronic medical record strongly preferred (Athena a plus)
• Experience with Microsoft Office, Word, Excel and Outlook