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 obtaining 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 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, 2-3 years experience in Referral/Billing Management
- Experience with Referral/Insurance Eligibility Programs, Microsoft Office including Word, Excel, Access
About Steward Health Care
Steward Health Care is the largest private, for-profit health care network in the United States. The company is owned and led by a management team of Steward physicians. Headquartered in Dallas, Texas, Steward employs more than 40,000 health care professionals and operates 35 hospitals across the United States and in the countries of Malta and Colombia which regularly receive top awards for quality and safety. The Steward network includes multiple urgent care centers and skilled nursing facilities, substantial behavioral health services, more than 7,000 beds under management, and approximately 2.2 million full risk covered lives through the company's managed care and health insurance services.
The Steward Health Care Network includes more than 5,000 physicians across 800 communities who help to provide more than 12 million patient encounters annually. Steward Medical Group, the company's employed physician group, provides more than six million patient encounters per year. The Steward Hospital Group operates hospitals in Malta, Colombia and nine states across the U.S., including Arizona, Arkansas, Florida, Louisiana, Massachusetts, Ohio, Pennsylvania, Texas, and Utah. For more information, visit www.steward.org.
Steward Medical Group is taking additional necessary preparations to ensure patients can receive compassionate care in safe, carefully managed environment – with confidence and without fear.
Our Safe and Ready program consists of a rigorous [three-point] standard ensuring patient safety, confidence and convenience.
- Any COVID-19 related care takes place in designated areas away from other patients and their families.
- A stringent cleaning policy has been implemented throughout our facilities.
- A strictly controlled visitor and mask policy is required for patient and colleague safety.