Financial Resource Specialist 1

Mercyhealth Wisconsin and Illinois•Rockford, IL

1d•Onsite

About The Position

Mercyhealth is seeking a Financial Resource Specialist to join their team. This role is responsible for administering financial policies, understanding collection laws, and managing patient accounts. The specialist will counsel patients on billing concerns, establish payment plans, process refunds, and communicate with various departments and insurance companies to ensure payment for services. They will also assist patients in obtaining financial assistance, screen for Medicaid eligibility, and complete insurance verification and pre-certifications. The role involves responding to patient inquiries, resolving denied claims, and acting as a liaison between patients, payors, and Mercyhealth partners. The specialist must meet department guidelines for patient contact and collection goals, maintain accurate documentation, and provide excellent customer service. They will also participate in educational programs and perform other assigned duties.

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.

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

Administer Mercyhealth financial policies and guidelines.
Maintain knowledge of collection laws, statement cycles, and the bad debt process.
Understand and follow frontline workflows for payment posting, cash drawer balancing, and cash compliance.
Research and audit patient accounts to determine balance responsibility (third party or patient).
Counsel patients in person or via phone on billing concerns, account balances, service costs, and insurance resources.
Establish and follow up on patient payment plans.
Process refunds and pay-in-full discounts.
Communicate with physicians, patient care staff, and reception regarding insurance status, medical urgency, and billing/insurance issues.
Identify if charges are correct and understand available information (medical record, chart view, MPI, billing, coding reviews) to assist in the process.
Navigate the billing system and review patient accounts for accuracy.
Initiate follow-up with patients, billing, coding, and insurance companies to ensure payment.
Maintain knowledge of managed care contract reimbursement rates and associated terminology.
Understand governmental and commercial insurance reimbursement rates and terminology.
Maintain knowledge of government programs, insurance marketplace, Care Credit, foundation grants, and other financial resources.
Assist patients in obtaining copay and drug replacement assistance.
Screen patients for presumptive eligibility for Medicaid and ensure coverage.
Complete insurance eligibility, benefit verification, and pre-certifications.
Monitor patient work queues and resolve outstanding balance issues.
Contact patients with self-pay balances for collection, payment arrangements, or financial resource assistance.
Respond to patient inquiries via in person, mail, phone, and/or email.
Send stat requests to appropriate departments to resolve patient issues.
Respond to third-party and patient requests on credit balances and initiate refund processes.
Act as a liaison between the patient, payors, and Mercyhealth partners.
Meet department guidelines for daily patient contact, collection goals, and benchmarks.
Document patient encounters accurately on the patient account/claim.
Ensure account status is accurately updated.
Perform service recovery to resolve patient concerns.
Manage complaints and grievances until resolution.
Research denied claims to reconcile information.
Manage access to insurance websites to assist patients with billing, claim, and denial concerns.
Use good judgment in emotional and demanding situations.
React to frequent changes in duties and volume of work.
Manage multiple tasks with ease and efficiency.
Work independently with minimal supervision and be result-oriented.
Promote teamwork and ensure high customer satisfaction.
Participate in educational programs for mandatory requirements and personal growth.
Perform other duties as assigned.