[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 normal daily operations.
• Reviews accounts based on patient or departmental inquiries and follows up with other Mercyhealth departments in a timely fashion if outstanding questions are not resolved and a claim is in jeopardy of not being paid.
• 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.
• Partners with the Revenue Cycle Training department to host shadowing sessions for new partner orientations to aid in sharing general knowledge about the role and its impact within the revenue cycle.
• 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 simultaneously.
• 2-3 years Revenue Cycle experience within the medical field required.
• Internal candidates must have scored a Level 4 or higher on the most recent annual evaluation.

Requirements

• Epic billing or HFMA CRC certification (or comparable certification).

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.
• 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.