Financial Resource Specialist 1

Mercyhealth Wisconsin and Illinois

1d•Onsite

About The Position

This role follows and administers Mercyhealth financial policies and guidelines, requiring in-depth knowledge of collection laws, statement cycles, and the bad debt process. The specialist will maintain a thorough knowledge base of the registration and cash drawer process, adhering to all frontline workflows, payment posting, cash drawer balancing, and cash compliance policies. Responsibilities include researching and auditing patient accounts to determine balance responsibility, counseling patients in person or via phone on billing concerns, account balances, service costs, and insurance resources, and establishing/following up on payment plans. The role involves processing refunds, pay-in-full discounts, and communicating with various departments and staff regarding patient billing and insurance issues. A thorough understanding of charge accuracy, available information resources (medical record, chart view, MPI, billing, and coding reviews), and navigating the billing system is essential. The specialist will initiate follow-up with patients, billing, coding, and insurance companies to ensure payment, and is familiar with managed care contract reimbursement rates, payment voucher terminology, and explanation of benefits. Understanding governmental and commercial insurance reimbursement rates, and maintaining extensive knowledge of financial resource programs (government, insurance marketplace, Care Credit, grants) is crucial. The role assists patients with copay and drug replacement assistance, screens for charity care and presumptive Medicaid eligibility, and completes insurance eligibility, benefit verification, and pre-certifications. Monitoring patient work queues, resolving outstanding balances, contacting patients for payment or assistance, and responding to inquiries via multiple channels are key duties. The specialist will send stat requests, respond to credit balance inquiries, and initiate refunds. Acting as a liaison between patients, payors, and Mercyhealth partners, meeting department guidelines for daily contact, collection goals, and benchmarks, and documenting all patient encounters accurately are required. The role involves high-level service recovery, managing complaints, researching denied claims, and managing access to insurance websites. The individual must use good judgment in emotional situations, react to frequent changes, manage multiple tasks efficiently, work independently with minimal supervision, and possess effective interpersonal skills to promote teamwork and ensure high customer satisfaction. Participation in educational programs for growth and meeting mandatory requirements is expected. Other duties as assigned.

Requirements

Graduate of high school preferred
Two years customer service and/or collections experience.
Knowledge of reimbursement practices for commercial and government payers preferred.
Medical terminology preferred.
Excellent oral and written communication skills/organizational skills.
Strong problem-solving skills.
Knowledge of various health care systems and databases desirable.
Knowledge of general computer applications (word, excel, outlook, etc.)
Ability to multitask and prioritize tasks accordingly
Ability to handle challenging conversations professionally
Ability to read and interpret documents such as emails, insurance documents, guidelines, instructions, and procedure manuals.
Ability to write routine reports and correspondence.
Ability to speak and communicate effectively with customers and other partners.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
Ability to compute rate, ratio, and percent and to draw and interpret basic graphs.
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
Ability to deal with problems involving several concrete variables in standardized situations.
Knowledge of general computer applications.
Database software, payor sites for claims and authorization statuses, and eligibility software, and Microsoft Office Suite (primarily Word and Excel).
Must be able to multitask and toggle between screens, document in different systems timely, thoroughly, and efficiently.
Good manual dexterity to operate keyboard and telephone; repetitive finger/wrist movement associated with use of keyboard; prolonged sitting.
Ability to lift or move office-related objects.

Nice To Haves

Ability to speak Spanish desirable.

Responsibilities

Follows and administers all Mercyhealth financial policies and guidelines.
Maintains a thorough knowledge base of the registration and cash drawer process.
Follows all necessary frontline workflows in regard to payment posting, cash drawer balancing and adheres to all cash compliance policies.
Researches and performs audits on patient accounts to determine where balances are due, from third party payers or patient responsibility.
Meets with patients in person or via telephone to counsel patients/customers on billing concerns, account balances, services costs/estimates, and various insurance resources.
Establishes payment plans with patients and follows up on broken payment arrangements when appropriate.
Researches patient accounts, processes refunds, and pay in full discounts.
Communicates with physicians, patient care staff and hospital/clinic reception regarding out of network insurance status, medical urgency, and other patient billing/ insurance issues.
Navigates the billing system and review patient accounts for accuracy.
Initiates appropriate follow-up with patients, billing department, coding department, and insurance companies to ensure payment for services.
Assists patients in obtaining copay and drug replacement assistance for services provided.
Screens patients in need and provides assistance with completion of the charity care application process.
Screens self-pay patients for presumptive eligibility for Medicaid and performs necessary follow-up to ensure coverage is in place.
Initiates appropriate follow-up with patients, insurance companies or billing department to ensure payment for services.
Completes insurance eligibility, benefit verification and pre-certifications as required.
Monitors patient work queues and resolve outstanding balance issues.
Contacts patients with self-pay balances to collect payment, set payment arrangements, or provide assistance with financial resources.
Responds to patient inquiries via in person, mail, phone, and/or email.
Sends stat requests to appropriate department and with the partner as needed to resolve patient issues/questions.
Responds to third party and patient requests on credit balances and initiates refund process in the event monies are due back to the payer or patient.
Acts as a liaison between the patient, payors, and Mercyhealth partners.
Meets Patient Access department guidelines for daily patient contact, collection goals, and department benchmarks.
Follows documentation standards on all patient encounters on appropriate patient account/claim utilizing notes.
Ensures account is updated to accurately reflect the current status.
Performs high level service recovery to resolve patient concerns.
Manages complaints and grievances and follows through until resolution is in place.
Researches denied claims through review of system/account/process to reconcile information.
Manages access to multiple insurance websites to assist patients will billing, claim, and denial concerns.
Provides training and mentoring.
Participates in educational programs to meet mandatory requirements and identified needs with regard to position and personal growth.
Performs other duties as assigned.