Financial Resource Specialist 1

Mercyhealth Wisconsin and Illinois•Mercyhealth Hospital and Medical Center - Walworth, WI

7d•$19 - $28•Onsite

About The Position

This role 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 understanding of registration and cash drawer processes, adhering to payment posting, cash drawer balancing, and cash compliance policies. Responsibilities include researching and auditing patient accounts to determine balance responsibility, counseling patients on billing concerns, account balances, service costs, and insurance resources, and establishing/following up on payment plans. The role involves communicating with various departments and external entities regarding patient billing and insurance issues, navigating the billing system, and initiating follow-up to ensure payment for services. A strong understanding of managed care, governmental, and commercial insurance reimbursement rates, as well as financial assistance programs, is essential. The specialist will assist patients with copay and drug replacement assistance, screen for charity care, and perform presumptive eligibility screenings for Medicaid. They will also complete insurance eligibility, benefit verification, and pre-certifications, monitor work queues, and respond to patient inquiries. The role requires managing denied claims, accessing insurance websites, and demonstrating good judgment in emotional situations, while also managing multiple tasks efficiently and working independently. Training and mentoring, participation in educational programs, and performing other assigned duties are also part of the role. The position emphasizes a Culture of Excellence, focusing on Quality, Service, Partnering, and Cost.

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

Knowledge of reimbursement practices for commercial and government payers
Medical terminology
Knowledge of various health care systems and databases
Ability to speak Spanish

Responsibilities

Administers all Mercyhealth financial policies and guidelines.
Maintains knowledge of collection laws, statement cycles, and the bad debt process.
Maintains knowledge of the registration and cash drawer process.
Follows frontline workflows for payment posting, cash drawer balancing, and adheres to cash compliance policies.
Researches and audits patient accounts to determine balance responsibility (third party or patient).
Meets with patients (in person or via phone) to counsel on billing concerns, account balances, service costs, and insurance resources.
Establishes payment plans with patients and follows up on broken arrangements.
Researches patient accounts, processes refunds, and pay-in-full discounts.
Communicates with physicians, patient care staff, and hospital/clinic reception regarding insurance status, medical urgency, and other billing/insurance issues.
Identifies if charges are correct and understands available information (medical record, chart view, MPI, billing, coding reviews).
Navigates the billing system and reviews patient accounts for accuracy.
Initiates follow-up with patients, billing, coding, and insurance companies to ensure payment.
Understands managed care, governmental, and commercial insurance reimbursement rates and terminology.
Maintains knowledge of government programs, insurance marketplace, Care Credit, foundation grants, and other financial resources.
Assists patients in obtaining copay and drug replacement assistance.
Screens patients for charity care and assists with application completion.
Screens self-pay patients for presumptive Medicaid eligibility and performs follow-up.
Completes insurance eligibility, benefit verification, and pre-certifications.
Monitors patient work queues and resolves outstanding balance issues.
Contacts patients with self-pay balances for collection, payment arrangements, or financial resource assistance.
Responds to patient inquiries via in person, mail, phone, and/or email.
Sends stat requests to appropriate departments to resolve patient issues.
Responds to third-party and patient requests on credit balances and initiates refund process.
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.
Ensures account is updated to accurately reflect the current status.
Performs high-level service recovery to resolve patient concerns.
Manages complaints and grievances through to resolution.
Researches denied claims to reconcile information.
Manages access to multiple insurance websites for billing, claim, and denial concerns.
Uses good judgment in emotional and demanding situations.
Reacts to frequent changes in duties and volume of work.
Manages multiple tasks with ease and efficiency.
Works independently with minimal supervision and is result-oriented.
Demonstrates effective interpersonal skills, including the ability to promote teamwork.
Ensures a high level of customer satisfaction.
Provides training and mentoring.
Participates in educational programs.
Performs other duties as assigned.