Financial Resource Specialist, Revenue Cycle - Day Shift

Mercy Health System Corporation•Woodstock, IL

34d•Onsite

About The Position

The Financial Resource Specialist, Revenue Cycle is responsible for administering financial policies and guidelines, with an in-depth understanding of collection laws, statement cycles, and the bad debt process. This role requires maintaining knowledge of registration and cash drawer processes, including payment posting, cash drawer balancing, and cash compliance. The specialist will research patient accounts to determine balance responsibility, counsel patients on billing concerns and insurance resources, establish payment plans, and process refunds. They will also communicate with various departments and insurance companies regarding billing and insurance issues, navigate the billing system, and initiate follow-up for payment. A thorough understanding of managed care, governmental, and commercial insurance reimbursement rates, as well as financial resource programs, is essential. The role involves assisting patients with copay and drug replacement assistance, screening for charity care and Medicaid eligibility, and completing insurance eligibility, benefit verification, and precertifications. The specialist will monitor work queues, resolve outstanding balances, respond to patient inquiries, and act as a liaison between payors, patients, and providers. This position is responsible for meeting department guidelines for patient contact, collection goals, and benchmarks, ensuring accurate account documentation and status updates, and performing service recovery for patient concerns. They will research denied claims, manage access to insurance websites, and demonstrate good judgment in emotional situations, with the ability to manage multiple tasks, work independently, and promote teamwork and customer satisfaction. The role also includes providing training to new partners and completing assigned educational courses.

Requirements

Graduate of high school.
Two to three years customer service and/or collections experience.
Knowledge of reimbursement practices for commercial and government payers.
Excellent oral and written communication skills/organizational skills.
Strong problem-solving skills.
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 to 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 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.

Nice To Haves

Medical terminology desired.
Knowledge of various health care systems and databases desirable.
Ability to speak Spanish desirable.

Responsibilities

Follow and administer all Mercyhealth financial policies and guidelines.
Maintain a thorough knowledge base of the registration and cash drawer process.
Follow all necessary frontline workflows in regards to payment posting, cash drawer balancing and adhere to all cash compliance policies.
Research and perform audits on patient accounts to determine where balances are due, from third party payers or patient responsibility.
Meet with patients in person or via telephone to counsel patients/customers on billing concerns, account balances, services costs/estimates and various insurance resources.
Establish payment plans with patients and follow up on broken payment arrangements when appropriate.
Research patient accounts, process refunds and pay in full discounts.
Communicate with physicians, patient care staff and hospital/clinic reception regarding out of network insurance status, medical urgency and other patient billing/ insurance issues.
Thorough understanding of how to identify if charges are correct.
In depth understanding of what information is available to assist in the process, such as the medical record, chartview, MPI, billing, and coding reviews as appropriate.
Navigate the billing system and review patient accounts for accuracy.
Initiates appropriate follow-up with patient, billing department, coding department, and insurance companies to ensure payment for services.
Maintain an extensive knowledge base of programs offered through the government, the insurance marketplace, Care Credit, foundation grants, and other financial resource options.
Assist 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 precertifications as required.
Monitor 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 payor, the patients and/or providers.
Responsible for meeting 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.
Research 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.
Ability to use good judgments in highly emotional and demanding situations.
Ability to react to frequent changes in duties and volume of work.
Ability to manage multiple tasks with ease and efficiency.
Ability to work independently with minimal supervision and be result oriented.
Effective interpersonal skills, including the ability to promote teamwork.
Ability to ensure a high level of customer satisfaction including employees, patients, visitors, physicians and external stakeholders.
Provides shadowing and training to new partners as identified by leadership.
Completes all required educational courses as assigned by leadership.
Performs other duties as assigned.