Financial Resource Specialist

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

49d•$19 - $30•Onsite

About The Position

The Financial Resource Specialist is responsible for administering Mercyhealth's financial policies and guidelines, with a strong emphasis on collection laws, statement cycles, and the bad debt process. This role requires in-depth knowledge of the registration and cash drawer process, including payment posting, cash drawer balancing, and cash compliance policies. The specialist will research and audit patient accounts to determine responsibility for balances, counsel patients on billing concerns, costs, and financial resources, and establish payment plans. They will also communicate with various healthcare professionals regarding patient billing and insurance issues, and possess a thorough understanding of charge accuracy, medical records, and billing systems. A key aspect of the role involves maintaining extensive knowledge of government programs, insurance marketplace options, and other financial assistance programs, assisting patients with applications and ensuring coverage is in place. The specialist will monitor work queues, resolve outstanding balances, respond to patient inquiries, and act as a liaison between payors, patients, and providers. Performance is measured against department guidelines for patient contact, collection goals, and benchmarks. The role also involves service recovery, managing complaints, and researching denied claims, requiring good judgment in emotional situations, adaptability, multitasking abilities, and the capacity to work independently. Providing shadowing and training to new partners and completing assigned educational courses are also part of the responsibilities.

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 various health care systems and databases desirable.
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.
While performing the duties of this job, the employee is regularly required to walk; use hands to finger, handle, or feel; reach with hands and arms; climb or balance; stoop, kneel, crouch, or crawl; and talk or hear.
The employee is frequently required to sit and work at a computer for long periods of time.
The employee is occasionally required to stand.
Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
While performing the duties of this job, the employee must have good manual dexterity to operate keyboard and telephone; repetitive finger/wrist movement associated with use of keyboard; prolonged sitting.
The employee must be able to lift or move office related objects.

Nice To Haves

Medical terminology desired.
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.
Research and perform audits on patient accounts to determine where balances are due.
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.
Communicate with physicians, patient care staff and hospital/clinic reception regarding out of network insurance status, medical urgency and other patient billing/ insurance issues.
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.
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.
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.
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.