St. Mary's Good Samaritan Professional Services Specialist in St. Louis, Missouri

Description

Role Purpose:

This position is responsible for assisting the Manager Hospital-Professional Integration in the management of hospital-based provider services for the Tri-State region to ensure that clinical services are properly documented, charged, coded, authorized and paid. Through audits and review of reports, ensures that the correct net revenue due through the billing process is maintained. This position will also be responsible for working with third party vendors and departments in which hospital-based provider services are charged to resolve issues and promote accurate billing and reimbursement.

Responsibilities:

  • Communicates with Manager of Hospital Professional Revenue Assurance (HPRA), providing updates of issues and concerns regarding daily operations and reconcilement that may involve third-party vendors.

  • Works with Manager of HPRA and third-party vendors to respond to providers’ needs in a timely, productive manner benefiting both providers and hospital facilities

  • Coordinates with manager, information systems, and the Information Center as needed to address and resolve issues related to operations, such as Epic work queue logic

  • Communicates with manager, third-party vendors, and clinical departments regarding reimbursement, medical necessity and reports on denials and electronic issues on an ongoing basis

  • Responsible for reconciling charges with provider documentation, outside vendors, and final bill as appropriate.

  • Serves as a resource person for the Revenue Integrity Department and Chargemaster to identify and request the addition of any CPT codes and modifiers found missing from preference lists

  • Serves as a work queue administrator for custom document

  • Works with the Epic team to create and maintain work queue

  • Assists with provider and staff in-services and education as needed

  • Works daily with third party coding company

  • Reconciles Urgent Care coding and monitors related work queue

  • Maintains and works pre-authorization spreadsheet to validate that procedures performed are coded accurately prior to billing to ensure appropriate reimbursement

  • Completes all assigned professional fee work queues on a daily basis

  • Works with PBS team and third party vendors to address charge errors and billing edits

  • Monitors accounts, provider schedules, and physician documentation to ensure services are accurately billed as hospital-based professional claims

  • Reconciles charges coded in Epic within 72 hours of coding

  • Reconciles documentation with charges to ensure there are charges entered for every patient account with documentation.

  • Works special projects and additional tasks as assigned

Qualifications

Minimum Requirements:

  • High school diploma or general education degree (GED)

  • Three to Five years of experience working in a Healthcare

  • Experience working with providers

  • Educated on National/local guidelines for Professional billing and coding.

  • Computer, Microsoft office (Excel), Compliance, Analytical and Communication skills

*SSM Health - System Office – *

SSM Health is one of the largest Catholic health systems in the country and is dedicated to quality and compassionate care for anyone in need, regardless of ability to pay. Based in St. Louis, where its System Office is located, SSM Health operates 20 hospitals in Wisconsin, Illinois, Missouri and Oklahoma. We provide care in various settings: outpatient sites, physician offices, a pharmacy benefit company, an insurance plan, hospitals, nursing homes, home care, hospice, telehealth and a technology company. _Our Mission: Through our exceptional health care services, we reveal the healing presence of God. _

Organization: SSM Health - System Office

Primary Location: Missouri-St. Louis-SSM Health System Office - 1145 Corporate Lake

Job: Finance, Billing, Accounting

Shift: Day Job

Req ID: 17011320