[Hiring] PFS Specialty Group Representative 1 @Mercyhealth Wisconsin and Illinois

Role Description

• Research and perform audits on patient accounts to determine balances are being billed to the correct payer.
• Thorough understanding of how to identify if charges on a patient's account are correct, utilizing information such as medical records, chart view, MPI, etc.
• In-depth understanding of collection laws pertaining to worker compensation and third party liability claims.
• Become fluent and knowledgeable in the Single Billing Office environment within Epic.
• Maintain a working knowledge of common billing and account resolution practices and requirements for hospital and/or clinic billing (SBO).
• Knowledge of how to work a claim from beginning to end.
• Learn and create in-depth knowledge of all applications used by Patient Financial Services partners such as Epic, Agility, Connex, Kronos, OneSource, Microsoft Word, Microsoft Outlook, Claim source, On-Base, etc.
• Identify the correct filing order per department processes when multiple insurances are involved.
• Respond to inquiries from patients, insurance companies, attorney offices, and outside vendors via mail, phone, and/or email.
• Respond to inquiries regarding credit balances on Workers Compensation, Third Party Liability, Hospice, Skilled Nursing Facilities, and Occupational Health accounts and initiate the refund process when necessary.
• Respond to billing reviews/inquiries from other PFS groups such as Billers, Follow-up, Cash posting, and Customer Service.
• Document all encounters on appropriate patient account/claim utilizing notes, ensuring account status is accurately reflected.
• Protect privacy and confidentiality of customers, patients, and partners in accordance with Mercyhealth policies, the Code of Ethics, and HIPAA laws.
• Review all Work Comp, TPL, and personal injury settlement requests before sending them to the Supervisor.
• Work on special projects and other job duties as assigned.
• Verify claims are received by the payer and follow up to obtain payment via phone calls, portal, or websites.
• Review failed claims and resolve disputed and denied claims.
• Obtain and send medical records as needed for Workers Compensation claims, Third Party Liability accounts, and attorneys' offices.
• Draft appeal letters when applicable based on payer requirements in a legible format related to the denied claim.
• Become familiar with ICD-10, CPT, and/or HCPCS Coding Systems as well as claim forms such as CMS-1500 and UB-04 and payer remittances.
• Call patients, payers, and attorney offices to obtain needed information to resolve account balances.
• Identify trends with payer denials and escalate these trends to leads/supervisors.
• Work with appropriate revenue cycle staff when performing account resolution functions.
• Responsible for working assigned work queues, reports, and spreadsheets.
• Participate in department meetings, workgroup meetings, and training sessions.
• Ability to adapt to change in a positive, sensitive, and forward-thinking manner in demanding situations.
• Maintain productivity standards as outlined in the Revenue Cycle department.

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.
• 2 - 3 years customer service experience preferred or 1 year customer service in the medical field preferred.

Requirements

• Proven ability to work effectively in a team environment.
• Strong typing/data entry experience.
• Strong organizational skills and attention to detail, accuracy, and follow-through.
• Knowledge of medical terminology preferred.

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.