Financial Resource Specialist 1

Mercy Health System Corporation•Riverside, IL

4d•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 healthcare professionals and insurance companies. A key aspect of this role involves assisting patients in navigating financial resources, including government programs, insurance marketplace options, and charitable assistance. The specialist will also handle insurance eligibility, benefit verification, and pre-certifications, monitor patient work queues, and respond to patient inquiries. This position requires strong problem-solving skills, the ability to manage multiple tasks efficiently, and excellent customer service skills to ensure patient satisfaction and resolve concerns. The role also involves training and mentoring, participating in educational programs, and performing 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

Ability to speak Spanish desirable.

Responsibilities

Administer Mercyhealth financial policies and guidelines.
Maintain knowledge of collection laws, statement cycles, and the bad debt process.
Understand and follow registration and cash drawer processes, including payment posting and cash drawer balancing.
Adhere to all cash compliance policies.
Research and audit patient accounts to determine balance responsibility (third party or patient).
Counsel patients in person or via telephone on billing concerns, account balances, service costs, and insurance resources.
Establish and follow up on payment plans with patients.
Process refunds and pay-in-full discounts.
Communicate with physicians, patient care staff, and reception regarding insurance status, medical urgency, and other billing/insurance issues.
Identify and ensure the accuracy of charges.
Utilize resources such as medical records, chart view, MPI, and billing/coding reviews.
Navigate the billing system and review patient accounts for accuracy.
Initiate follow-up with patients, billing, coding, and insurance companies to ensure payment.
Understand managed care contract reimbursement rates and terminology.
Understand governmental and commercial insurance reimbursement rates and terminology.
Maintain knowledge of financial resource programs (government, insurance marketplace, Care Credit, grants, etc.).
Assist patients with copay and drug replacement assistance.
Screen patients for charity care and assist with applications.
Screen self-pay patients for presumptive Medicaid eligibility 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 patient accounts/claims.
Update accounts to reflect current status.
Perform service recovery to resolve patient concerns.
Manage complaints and grievances through to resolution.
Research denied claims to reconcile information.
Manage access to insurance websites for billing, claim, and denial concerns.
Use good judgment in emotional and demanding situations.
React to frequent changes in duties and work volume.
Manage multiple tasks with ease and efficiency.
Work independently with minimal supervision and be result-oriented.
Promote teamwork and ensure high customer satisfaction.
Provide training and mentoring.
Participate in educational programs for mandatory requirements and identified needs.
Perform other duties as assigned.