A Passion for Making Lives Better
Patient Financial Services Group Representative, Patient Accounts, Janesville, Days, 80 hrs/2 wks
Location: Mercycare Building – Janesville
Hybrid and flexible work schedule opportunities available after probationary period
Experience a rewarding and fulfilling career with Mercyhealth. Mercyhealth is committed to offering our partners a best place to work. Our unique workplace Culture of Excellence is built upon:
Employee engagement, empowerment and growth
Teamwork toward our common goal – providing exceptional health care services with a passion for making lives better
An atmosphere of caring and quality that cascades throughout the organization
Essential duties and Responsibilities
Research and preform 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. In depth understanding of what information is available to assist in the process, such as the medical records, chart view, MPI, etc.
In-depth understanding of collection laws pertaining to worker compensation and third party liability claims.
Fluent and knowledgeable in the Single Billing Office environment within Epic
Maintains 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
In-depth knowledge of all applications used by Patient Financial Services partners such as: Epic, Retired Epic, Athena, Kronos, OneSource, Microsoft Word, Microsoft Outlook, Claim source, On-Base, etc.
Identifies the correct filing order per department processes when multiple insurances are involved
Responds to inquiries from patients, insurance companies, Attorney offices and outside vendors via mail, phone and/or email.
Responds to inquiries regarding credit balances on workers compensation and/or third party accounts and initiates the refund process in the event monies are due back to the payer or patient.
Responds to Billing reviews/ inquiries from other PFS groups such as Billers, Follow-up, Cash posting and Customer Service.
Protects 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 special projects and other job duties as assigned
Verifies claims are received by the payer and follows up to obtain payment via phone calls, portal or websites.
Reviews failed claims, resolves disputed and denied claims.
Obtains and sends medical records as needed for workers compensation claims, third party liability accounts and attorneys’ offices.
Drafts appeal letters when applicable based on payer requirement in a format that is legible and relates to the denied claim.
Needs to be familiar with ICD-10, CPT, and/or HCPCS Coding Systems as well as claim forms such as CMS-1500 and UB-04 as well as payer remittances.
Calls patients, payers and attorney offices without hesitation to obtain needed information to resolve account balances.
Identify trends with payer denials and escalates these trends to leads/supervisors.
Works with appropriate revenue cycle staff when performing account resolution functions.
Responsible to work 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
Maintains productivity standards as outlined in the Revenue Cycle Department
Education and Experience
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 medical field preferred.
Special Physical Demands
The Special Physical Demands are considered Essential Job Functions of the position with or without reasonable accommodations.
While performing the duties of this job, the employee is regularly required to use hands to finger, handle, or feel; reach with hands and arms and talk or hear. The employee is frequently required to sit. The employee is occasionally required to stand; walk; climb; or balance and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
To apply for this job email your details to firstname.lastname@example.org