Job Description

Category:
Administrative/ Clerical

Facility:
SMG - Boston/Brighton Area - Revenue Mgmt.

Department:
PPSC Billing Center Admin

Req Number:
55050

Job Details:

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.

POSITION SUMMARY:

The Patient Financial Services (PFS) representative will serve as a primary support to Steward Medical Group (SMG) patients regarding any concerns related to billing, self-pay balances, insurance payments, and all other financial matters. This position will also help in collection of patient payments, setting up payment agreements and assisting in portal services.

KEY RESPONSIBILITIES:

* Provide patients with World Class service
* Answer incoming patient phone calls and make outbound collection calls on open balances
* Update patient insurance, confirming eligibility and queue claims for billing
* Update demographic and guarantor information in the Patient Accounting System
* Act in a professional manner and treat patients, co-workers, and leadership with respect at all times
* Troubleshoot and identify patient billing issues to resolve them to patient's satisfaction
* Ability to explain and discuss SMG and PFS policies for better patient understanding
* Educate patients about third party and insurance processes, their plan benefits, and how they affect patient balances
* Evaluate accounts from both an insurance and self-pay perspective
* Evaluate accounts for self-pay refunds
* Manage and work queues and worklists in patient billing system
* Advocate for patients and contact insurance companies on their behalf, when necessary, to resolve disputes
* Assist with patients with access to the Patient Portal and password resets
* Set up payment plans, monitor and make outbound calls to patients with broken promise to pay agreements
* Ability to approach patient and discuss open, unpaid or overdue balances
* Receive and process patient credit card payments, and allocate to appropriate visits on the account
* Evaluate accounts for bad debt placement and wok with bad debt vendor on patient issues and concerns
* Post appropriate discounts and adjustments to patient accounts
* Interact with supporting departments; coding, cash-ops, AR follow up to resolve billing and payment issues
* Interact with Practices to communicate and work cooperatively regarding patient billing issues
* Maintain expected performance metrics
* Other duties as assigned

REQUIRED KNOWLEDGE & SKILLS:

* Knowledge of insurance rules/regulation and policies
* Professional Working Revenue Cycle experience in either an AR follow up, Cash-Ops, denial management or self-pay role
* Ability to bring tasks to completion in a manner satisfactory go all
* Ability to communicate with others effectively in a concise manner, in order to bring issues effectively to a resolution
* Ability to identify billing trends affecting patient balances
* Ability to evaluate situations and escalate issues appropriately
* Ability to multitask, and ability to follow through with our patients and contacts
* Ability to read, understand and interpret insurance Explanation of Benefits
* Prior experience with Athena preferred
* Experience with Excel, Word and Outlook required
* Organizational, time management skills
* Ability to think globally about the patient experience

EDUCATION/EXPERIENCE/LICENSURE/TECHNICAL/OTHER:

Education: Associates degree or relevant work experience required
Experience: Medical billing, preferably in a professional setting, required
Software/Hardware: Athena and Meditech experience preferred




Application Instructions

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