Patient Financial Services Follow-Up Rep, Revenue Cycle - Day Shift

<p><b>ESSENTIAL DUTIES AND RESPONSIBILITIES</b></p><ul><li>Verifies claims are received by the payer and follows up to obtain payment via phone calls, portal or website use.</li><li>Reviews claim adjustment reason codes or explanations of benefits received by the payer to determine what reasons for denials records are indicating for appropriate follow-up.</li><li>After denial review, evaluates next steps and takes action to call payer, follows up with a resubmission or <span style="overflow-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">dispute/appeal/reconsideration</span> as required by payer, or works internally to receive payment on account.</li><li>Drafts an appeal or complete reconsideration forms when applicable based on payer requirements in a format that is logical and relates to the open denial of payment.</li><li>Obtains and sends medical records during the appeals process when needed to substantiate medical necessity.</li><li>Ability to review billing forms for both paper submissions and electronic submissions for accuracy.</li><li>Calls patients or payers directly without hesitation to obtain needed information to resolve an account balance when applicable.</li><li>Identify trends with payor rejections or denials and escalates these trends to leads/supervisors.</li><li>Uses computer systems/technology to locate claims information to resolve account balances.</li><li>Maintains compliance with patient financial services policies and procedures.</li><li>Uses fax machine and other office equipment during the course of normal daily operations.</li><li>Reviews accounts based on patient or departmental inquiries. Also, works 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.</li><li><span><span> </span>Interacts with other Patient Financial staff members to provide pertinent information, <span>which may include training and document sharing</span>, and to ask for guidance to resolve knowledge base deficiencies.</span></li><li>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.</li><li>Works billing functions when needed.</li><li>Escalates high dollar accounts for a second level appeal if needed.</li><li>Reports equipment malfunctions and supply needs, as necessary.</li><li>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. Apply creative problem-solving skills in order to overcome obstacles and resolve errors for claim adjudication.</li><li>Coordinates with management and external departments to resolve unresolved accounts and potentially create process redesign initiatives for long term root cause resolution.</li><li>Completes special projects as assigned.</li><li>Maintains a comprehensive awareness of all insurance company updates including Federal and State guidelines.</li><li>Meets productivity goals as assigned by the Revenue Cycle Director.</li></ul><p></p><p><b>EDUCATION AND/OR EXPERIENCE</b></p><p>High school diploma or equivalent.<br>Microsoft Excel required and healthcare billing experience preferred.<br>Undertakes self-development activities.<br>Basic understanding of working in multiple software applications at the same time.</p><p></p><p></p><p><b>PAY RANGE:</b></p><p></p>$17.92 - $26.88<p></p><p>Mercyhealth is an <a href="https://www.mercyhealthsystem.org/careers/" target="_blank" rel="noopener noreferrer"><span style="color:#0000ff"><u>Equal Opportunity Employer</u></span></a>. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identify, national origin, disability, or protected veteran status.</p><p></p><p></p><p>Mercyhealth offers competitive pay and a comprehensive benefits package including: </p><p></p><ul><li><p>Medical, Dental, Vision</p></li><li><p>Life & Disability Insurance</p></li><li><p>FSA/HSA Options</p></li><li><p>Generous, accruing paid time off</p></li><li><p>Paid Parental and caregiver leave</p></li><li><p>Career advancement and educational opportunities</p></li><li><p>Tuition and certification reimbursement</p></li><li><p>Certification Reimbursement</p></li><li><p>Well-being Programs</p></li><li><p>Employee Discounts</p></li><li><p>On-Demand Pay</p></li><li><p>Financial Education</p></li><li><p>Annual recognition/awards events</p></li><li><p>Partner appreciation days</p></li><li><p>Family <span style="overflow-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">entertainment/attractions</span> discount</p></li><li><p>Community service/improvement opportunities</p></li></ul><p></p><p>Click <a href="https://www.mercyhealthsystem.org/join-our-team/benefits/" target="_blank" rel="noopener noreferrer"><span style="color:#0000ff"><u>here</u></span></a> for more details regarding Mercyhealth Careers Benefit Information.</p><p></p><p></p><p>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 across seven hospitals, 85 primary and specialty clinics, and a team of over 7,500 professionals serving northern Illinois and southern Wisconsin.</p><p></p><p>Mercyhealth has been nationally recognized for our commitment to our people and culture, including: </p><p></p><ul><li><p>#1 in the nation on AARP's Best Employers for Workers Over 50</p></li><li><p>One of Working Mother magazine's 100 Best Companies for Working Mothers</p></li><li><p>A Top 50 Company and Top 10 Nonprofit for Executive Women</p></li></ul><p></p><p></p><p></p>

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