Sioux San
Business Office
(605) 355 - 2358

  The Business Office is responsible to plan, implement, direct, manage, and coordinate all patient registration activities, third party billing, and the accounts receivable information.

  The Business Office will provide a patient benefit coordinator who is responsible to work closely with the patient and all facility staff in the identification and utilization of all alternate resources available to the American Indian population.  The Business Office accepts referrals from all facility staff (Providers, Contract Health Service, and Social Services) to assist patients and families in applying for alternate resources, which will help maximize third party collections.   The patient benefit coordinator will interview inpatients, OB/GYN patients, new mothers, and outpatients on a daily basis.  The patient benefits coordinator will assist Patient Registration to verify all third party resources and key-enter any received or changed insurance information into the Patient Registration software.

  The patient benefit coordinator will work closely with the admissions clerk to screen potential eligible.  The patient benefit coordinator will also do pre-certification for private insurance admissions.  The patient benefit coordinator will establish communication lines with Social Security offices, State Medicaid offices, Medicare Fiscal Intermediary, and other disciplines.

  The Business Office Duties include preparing claims for reimbursement from third party resources rendered in an efficient and timely manner.  This task is accomplished by abstracting and interpreting data from third party billing software, PCC data, and charge tickets.  The Patient Account Technicians must use knowledge of ICD-9-CM, CPT-4, HPPC, and revenue coding to assure maximum reimbursement of third party resource claims.  All claims must be submitted in a timely manner, by printing and mailing or electronic submission.

  The Business Office is responsible to maintain the Accounts Receivable system by posting payments, denials, etc...  This task is accomplished by abstracting accurate information from the explanation of benefits and the remittance advises.  The remittance advises and explanations of benefits are reviewed to assure maximum reimbursement by appealing denials, crossover billing, and errors.

  The Business Office reeives all private insurance checks.  One employee is shared with Contract Health Service to be accountable for all checks received and creating collection batches in the Accounts Receivable software.

  The Business Office provides leadership, public relations activities, education and serves as a communication line for patients and staff with all third party resources to communicate new guidelines and regulations.  The Business Office will assist with marketing our services by encouraging our patients to choose our hospital as their primary care provider.

Goals and Objectives

1. To establish and acheive yearly collection goals, as approved by the service unit chief executive officer.
2. To effectively communicate with all third paty resources, patients, staff, and administration in obtaining an effective collection process.
3. To be courteous to the patient as they present for care, obtain accurate patient information and key-enter into the RPMS system.
4. To achieve 100% patient registration.
5. Respond to all correspondence within 10 days of receipt.
6. To provide leadership, good public relations, education, and serve as a communication line for our patients and the staff for all third party information and regulations.
7. To be in compliance with all new regulations, laws, and guidelines pertaining to submitting third party claims.
8. Identify and assist patients to apply for any third party resource they may be eligible for.
9. To maintain an accurate accounts receivable register and provide good reports.
10. To help market our hospital's services, to be provider of choice.