SSM Health Financial Clearance Specialist in St. Louis, Missouri
Under general supervision and following established policies and procedures, supports the financial portion of the patient care experience through collaboration with other department, coordination of the needs of the patients, scheduling of appointments, accurate and timely verification of insurance eligibility and benefits, obtaining pre-certification, and registration. Estimates, communicates, and collects patient financial responsibility, educating the patient of financial programs/opportunities and timely follow up. Ensures compliance of payer regulations and actively works open denial reports to ensure appropriate and timely payment.
Enhances the overall patient care experience by minimizing wait times through efficient work processes and communication of delays, proactively meeting the patient needs, and utilizing the available tools and resources, as evidenced by patient satisfaction scores and leadership observations.
Enhances effective operations of the department through participation in a minimum of 50% of department meetings, reads and initials minutes for meetings not attended, participation in process improvement activities to achieve goals as evidenced by attendance record and completed process improvement action items.
Secures appropriate payment for services provided by the organization through verification of eligibility and specific benefits for procedures and services; coordination with physician office staff and third party payers to ensure precertification and notification requirements are met; accurate estimation, communication and collection of financial responsibility and/or financial programs to patients; ensuring timely follow up; and maintaining a consistent level of productivity avoiding levels of extremely high and very low productivity, as evidenced by the lack of denials, quality audits, key performance indictors and point of service collections.
Demonstrates streamlined processes to maintain safety and quality through accurate patient identification, validates/updates Master Patient Index (MPI) according to departmental policy, protects personal health information, and accurately interprets physician orders, as evidenced by quality audits and reviews.
Collaborates with departments and co-workers to enhance physician and patient satisfaction by utilizing available technologies to streamline verification and financial processes, reduce redundancy of information requested and monitor insurance verification issue/opportunities with third party payers, and provide feedback to direct manager for implementation of process improvement, as evidenced by quality audits and completed process improvement action items.
Timely scheduling, pre-registration and registration of patient appointments as evidenced by quality audits and satisfaction surveys.
Actively works denial report for open denials. Researches missing information and accurate insurance coverage and corrects accounts.
Identifies opportunities for improvement and communicates them to leadership.
High School or Equivalent (GED)
Three years of medical office experience.
Knowledge of ICD-9/ICD-10 and CPT coding, insurance precertification, insurance claims, and patient registration.
SSM Health St. Mary's Hospital – St. Louis –
The 525-bed SSM Health St. Mary's Hospital - St. Louis is a major teaching hospital affiliated with the Saint Louis University Department of Obstetrics and Gynecology. St. Mary's Hospital - St. Louis offers a wide variety of outpatient services, including cardiovascular and open-heart surgery, high-risk obstetrics and comprehensive women's breast health services. The hospital was recognized with the 2008 and 2010 Premier Award for Quality.
Our robust employee benefits package includes health benefits, life and accidental death and dismemberment insurance, long-term disability coverage, health and dependent care reimbursement accounts, paid time off, tuition reimbursement, adoption reimbursement, an employee assistance program, retirement plan options and more.
Note: not all benefits apply to all openings.
Req ID: 18014895
Primary Location: Missouri-St. Louis-SSM Health St. Mary’s Hospital – St. Louis
SSM Health St. Mary’s Hospital – St. Louis (0100) 6420 Clayton Road St. Louis, 63117
Schedule Hours Per Pay Period: 63117
Weekend Rotation: Full Time, Days
Normal work hours: Clerical & Customer Service
Job: SSM Health St. Mary’s Hospital – St. Louis
Organization: SSM Health St. Mary's Hospital – St. Louis
Work Locations: SSM Health St. Mary’s Hospital – St. Louis (0100) 6420 Clayton Road St. Louis, 63117