This position is responsible for financial clearance of the patient account which includes initiating insurance verification, notification, pre-certification, authorization and obtaining reference numbers (as appropriate) for all Inpatient, Observation and Outpatient Services. Counsels the patient regarding their financial obligation, insurance benefits and appropriately communicate the patient liability. Acts as a liaison for the patient, physician office, care management team, community agencies and the Revenue Service Center.
Verifies the ordering clinician credentials for add on outpatient encounters if not verified by the scheduling department at the time of scheduling.
Works daily reports to ensure all payer specific billing requirements and authorization requirements are met.
Obtains and verifies necessary demographic and billing information and updates that information in the eSummit system.
Collects amounts owed for medical services including contacting the patient to secure payment.
Assists with the follow up on appeals, denials, answer inquiries and update accounts as necessary.
Identifies problems and communicates with the Revenue Service Center, Care Management team, Payer Relations and insurance companies in a timely manner.
Remains flexible in scheduling to meet department and organizational needs to accommodate the scheduling process.
High School Diploma or Equivalent
More than 1 year and less than 3 years
More than 3 years and less than 5 years
Two or more years in a hospital medical office or insurance experience.
Three or more years collection experience
Licensure, Certification or Registration
CHAA (Certified Health Access Associate)
Other: Knowledge, Skills and Abilities
Knowledge of state Medicaid/Medicare programs Knowledge of payment assistance/charity programs Knowledge of payer requirements for authorization and billing Knowledge of ICD-9, ICD-10 and CPT coding Effective interpersonal and communication skills, including written, verbal and email etiquette. Proven customer service/problem solving skills. Proficient computer skills with MS Office products, including Outlook, Word and Excel. Knowledge of HIPAA regulations
General knowledge of hospital billing preferred Medical Terminology preferred
Other combinations of formal education, training and experience may be considered.
SCL Health is a faith-based, nonprofit healthcare organization that operates eight hospitals, four safety net clinics, one children’s mental health center and more than 190 ambulatory service centers in three states – Colorado, Kansas and Montana. The health system includes 15,000 full-time associates and more than 500 employed providers.