Offer summary

Qualifications:

Basic knowledge of medical coding and terminology., Understanding of third-party insurance procedures and payer guidelines., Proficiency with payer websites and resources., Highly organized with strong attention to detail..

Key responsibilities:

Resolve outstanding and denied claims within established timelines.

Collaborate with hospital departments and insurance companies to ensure proper claim resolution.

Resubmit accurate claims and prepare appeals as needed.

Monitor denials and escalate issues to supervisors.

Nearly a decade ago, Steward Health Care System emerged as a different kind of health care company designed to usher in a new era of wellness, one that provides our patients better, more proactive care at a sustainable cost, our providers unrivaled coordination of care, and our communities greater prosperity and stability. As the country’s largest physician-led, tax paying, integrated health care system, our doctors can be certain that we share their interests and those of their patients.Together we are on a mission to revolutionize the way health care is delivered - creating healthier lives, thriving communities and a better world.Steward is among the nation’s largest and most successful accountable care organizations (ACO), with more than 6,600 providers and 43,000 health care professionals who care for 12.3 million patients a year through a closely integrated network of hospitals, multispecialty medical groups, urgent care centers, skilled nursing facilities and behavioral health centers.Based in Dallas, Steward currently operates 39 hospitals across Arizona, Arkansas, Florida, Louisiana, Massachusetts, Ohio, Pennsylvania, Texas, and Utah.The Steward Health Care Network includes 5,000 physicians across 800 communities who help to provide more than 12 million patient encounters per year. 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 and nine states across the U.S., including Arizona, Arkansas, Florida, Louisiana, Massachusetts, Ohio, Pennsylvania, Texas, and Utah.

Job description

This position is responsible for the resolution of outstanding and/or denied claims based on third party claim processing rules within established timelines. The Revenue Cycle Associate reports to the central business office supervisor or manager.

Meets goals and objectives in assigned area;
Complies daily with departmental policies and procedures;
Performs collection activity to ensure proper resolution and reimbursement on claims;
Provides thorough, courteous, and professional assistance to coworkers and patients;
Ensures that all claims are billed and collected and meet all government mandated policies for Integrity and Compliance;
Collaborates with hospital departments in the resolution of accounts;
Resolves claims processing issues with third party payers and provide all required information timely; involves patients and family members (where necessary) to ensure timely resolution of claims with insurance companies;
Resubmits clean and accurate claims to insurance companies in a timely and compliant manner;
Researches, prepares, and submits appeals to insurance companies;
Details all actions taken on account with clear and concise notes;
Monitors and recognizes denials and/or issues that may be trends and escalate to supervisor as needed; and
Maintain strict confidentiality and adhere to all HlPAA guidelines/regulations.
Knowledge of basic medical coding/terminology and third-party insurance operating procedures and practices a plus;
Understands payer guidelines related to effective claim resolution;
Knowledgeable and proficient with payer websites and other useful resources;
Knowledge of revenue cycle and/or business office procedures;
Highly detail oriented and organized;
Ability to read, understand, and follow oral and written instructions; and
Ability to establish and maintain effective working relationships and communicate clearly with customers and insurance companies both within and outside of Steward.