A Passion for Making Lives Better
Location: Fully remote options for those with experience, or Janesville, WI, or Rockford, IL
Hybrid remote optional as well and flexible work schedule available
Mercyhealth is committed to offering our partners a best place to work and continually evaluates new programs and benefits. We have been recognized locally, regionally and nationally for helping our workers achieve a work/life balance through benefit offerings and innovative programs.
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
Verifies claims are received by the payer and follows up to obtain payment via phone calls, portal or website use.
Reviews claim adjustments or explanations of benefits received by the payer to determine appropriate follow-up.
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 appeals or completes reconsideration forms when applicable based on payer requirements to obtain payment of claims.
Obtains and sends medical records needed to move claims to resolution.
Ability to review billing forms for paper and electronic submissions for accuracy.
Calls patients or payers directly without hesitation to obtain needed information to resolve an account balance when applicable.
Identify 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. Also, works with other Mercyhealth departments in a timely fashion to resolve outstanding balances.
Interacts with other staff members to provide pertinent information and to ask for guidance to resolve knowledge base deficiencies.
Researches accounts at a higher level that are denied to appeal or escalate as needed.
Apply creative problem solving skills in order to overcome obstacles and resolve errors for claim adjudication.
Coordinates with management and external departments to resolve 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.
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.
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 talk or hear. The employee is most often required to sit; use hands to finger, handle, or feel and reach with hands and arms. The employee is occasionally required to stand; walk 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, depth perception and ability to adjust focus.
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