[Hiring] Patient Financial Services Follow Up 1 @Mercyhealth Wisconsin and Illinois

Role Description

• Verifies claims are received by the payer and follows up to obtain payment via phone calls, portal or website use.
• Reviews claim adjustment reason codes or explanations of benefits received by the payer to determine reasons for denials for appropriate follow-up.
• After denial review, evaluates next steps and takes action to call payer, follows up with a resubmission or dispute/appeal/reconsideration as required by payer, or works internally to receive payment on account.
• Drafts an appeal or complete reconsideration forms when applicable based on payer requirements in a logical format related to the open denial of payment.
• Obtains and sends medical records during the appeals process when needed to substantiate medical necessity.
• Ability to review billing forms for both paper submissions and electronic submissions for accuracy.
• Calls patients or payers directly without hesitation to obtain needed information to resolve an account balance when applicable.
• Identifies trends with payor rejections or denials and escalates these trends to leads/supervisors.
• Uses computer systems/technology to locate claims information to resolve account balances.
• Maintains compliance with patient financial services policies and procedures.
• Uses fax machine and other office equipment during the course of normal daily operations.
• Reviews accounts based on patient or departmental inquiries and works with other Mercyhealth departments in a timely fashion if outstanding questions are not resolved.
• Interacts with other Patient Financial staff members to provide pertinent information, which may include training and document sharing, and to ask for guidance to resolve knowledge base deficiencies.
• Researches accounts at a higher level that are denied for No Authorization as a priority in the attempt to appeal or escalate to Precertification department if a retro authorization may be needed.
• Works billing functions when needed.
• Escalates high dollar accounts for a second level appeal if needed.
• Reports equipment malfunctions and supply needs, as necessary.
• Accesses available resources, such as the patient accounting system, biller files, other areas in the Revenue Cycle, or payer databases, to locate missing or incorrect information.
• Applies creative problem-solving skills to overcome obstacles and resolve errors for claim adjudication.
• Coordinates with management and external departments to resolve unresolved accounts and potentially create process redesign initiatives for long-term root cause resolution.
• Completes special projects as assigned.
• Maintains a comprehensive awareness of all insurance company updates including Federal and State guidelines.
• Meets productivity goals as assigned by the Revenue Cycle Director.

Qualifications

• High school diploma or equivalent.
• Microsoft Excel required and healthcare billing experience preferred.
• Undertakes self-development activities.
• Basic understanding of working in multiple software applications at the same time.

Requirements

• Basic business writing skills.
• Should understand how to work with others to impact change.

Special Physical Demands

• Regularly required to talk or hear.
• Most often required to sit; use hands to finger, handle, or feel and reach with hands and arms.
• Occasionally required to stand; walk; stoop; kneel; crouch; or crawl.
• Must occasionally lift and/or move up to 25 pounds.
• Specific vision abilities required include close vision, distance vision, color vision, depth perception, and ability to adjust focus.

Pay Range

$17.92 - $26.88

Benefits

• Medical, Dental, Vision
• Life & Disability Insurance
• FSA/HSA Options
• Generous, accruing paid time off
• Paid Parental and caregiver leave
• Career advancement and educational opportunities
• Tuition and certification reimbursement
• Well-being Programs
• Employee Discounts
• On-Demand Pay
• Financial Education
• Annual recognition/awards events
• Partner appreciation days
• Family entertainment/attractions discount
• Community service/improvement opportunities

Company Description

At Mercyhealth, we don’t simply hire people, we empower employee-partners who are passionate about making lives better. As an integrated health system, we deliver exceptional, coordinated care across seven hospitals, 85 primary and specialty clinics, and a team of over 7,500 professionals serving northern Illinois and southern Wisconsin.

Mercyhealth has been nationally recognized for our commitment to our people and culture, including:

• #1 in the nation on AARP's Best Employers for Workers Over 50
• One of Working Mother magazine's 100 Best Companies for Working Mothers
• A Top 50 Company and Top 10 Nonprofit for Executive Women