Steward Health Care is the largest private, tax-paying physician-led health care network in the United States. Headquartered in Dallas, Texas, Steward operates 35 hospitals in the United States and the country of Malta that regularly receive top awards for quality and safety. The company employs approximately 42,000 health care professionals. The Steward network includes multiple urgent care centers and skilled nursing facilities, substantial behavioral health services, over 7,900 beds under management, and approximately 2.2 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, Pennsylvania, Ohio, Florida, Utah, Arizona, Texas, Louisiana and Arkansas, and provides more than 4 million patient encounters per year.
Responsible for the complete and accurate capture of patient insurance data and referral / authorization management. Includes tracking and creation of referrals for all visits. Contacts patients by telephone to collect missing pertinent data. Communicates with referring physicians and/or practices to obtain prior approvals for services. Reviews and responds to denied claims and works toward denial recovery. In addition, he/she will perform other related duties as required.
- Provides superior customer service to internal and external clients, customers, and patients as referenced in the Service Excellence Standards.
- Practices and promotes a "patient-centered care model" within administrative standards.
- Provides primary fiscal management of all patient insurance and insurance referral data. The principle focus is to ensure that all pending services have appropriate insurance coverage and is reimbursable. If a patient has no insurance coverage a free care application and approval must be on file at CSEMC prior to rendering services. It is the expectation that all pending services will be cleared for reimbursement 5 business days prior to the appointment date (unless it was added to the appointment schedule within that time frame).
- It is expected that all telephone communication will be answered or initiated in a cheerful and welcoming manner as per the policy of CSEMC.
- Review and respond to all insurance rejection and/or claim denial reports for CSEMC and professional billing agencies. Initial review will be made in collaboration with the Manager and/or Practice Coordinator. However, the Billing / Referral Coordinator is responsible for follow through of the recommendations made and achieving denial recovery of those charges. All responsive documentation is to be retained and filed for continual monitoring and follow up.
- Coordination of all office supplies and documents.
- Perform all other related or similar duties as required or as requested by the attending-in-charge or the Managing Director.
- Participates in role expansion, personal and center development.
- Assist with administrative cross-coverage and other assigned duties.
- Associates Degree preferred
- 2-3 years’ experience in Referral/Billing Management
- Familiarity with Referral/Insurance Eligibility Programs
- Proficient with Microsoft Office including Word, Excel, Access