Patient Financial Services Follow-Up Rep, Revenue Cycle - Day Shift

Mercyhealth Wisconsin and Illinois•Remote-Illinois, IL

2d•$18 - $27•Onsite

About The Position

This role is responsible for verifying claims, following up on payments, and resolving claim denials. The representative will review explanations of benefits, determine next steps for payment, and draft appeals or reconsideration forms. They will also obtain and send medical records when necessary, review billing forms for accuracy, and contact patients or payers directly to resolve account balances. The position involves identifying trends in payor rejections, using computer systems to locate claim information, and maintaining compliance with policies. The representative will also work with other departments to resolve outstanding issues and collaborate with Patient Financial staff for information sharing and guidance. A key responsibility includes researching and appealing claims denied for 'No Authorization' and escalating high dollar accounts for second-level appeals. The role requires reporting equipment malfunctions, accessing various resources to find information, and applying problem-solving skills for claim adjudication. Coordination with management and external departments is necessary for resolving accounts and potentially redesigning processes. The representative must stay updated on insurance company changes and federal/state guidelines, and meet productivity goals.

Requirements

High school diploma or equivalent.
Microsoft Excel required.
Basic understanding of working in multiple software applications at the same time.

Nice To Haves

Healthcare billing experience preferred.
Undertakes self-development activities.

Responsibilities

Verifies claims are received by the payer and follows up to obtain payment via phone calls, portal or website use.
Reviews claim adjustment reason codes or explanations of benefits received by the payer to determine reasons for denials and appropriate follow-up.
Evaluates next steps after denial review and takes action to call payer, follows up with a resubmission or dispute/appeal/reconsideration as required by payer, or works internally to receive payment on account.
Drafts an appeal or complete reconsideration forms when applicable based on payer requirements.
Obtains and sends medical records during the appeals process when needed to substantiate medical necessity.
Reviews billing forms for both paper and electronic submissions for accuracy.
Calls patients or payers directly to obtain needed information to resolve an account balance.
Identifies trends with payor rejections or denials and escalates these trends to leads/supervisors.
Uses computer systems/technology to locate claims information to resolve account balances.
Maintains compliance with patient financial services policies and procedures.
Uses fax machine and other office equipment during the course of normal daily operations.
Reviews accounts based on patient or departmental inquiries.
Works and follows up with other Mercyhealth departments in a timely fashion if outstanding questions are not resolved and a claim is in jeopardy of not being paid.
Interacts with other Patient Financial staff members to provide pertinent information, which may include training and document sharing, and to ask for guidance to resolve knowledge base deficiencies.
Researches accounts denied for No Authorization as a priority in the attempt to appeal or escalate to Precertification department if a retro authorization may be needed.
Works billing functions when needed.
Escalates high dollar accounts for a second level appeal if needed.
Reports equipment malfunctions and supply needs, as necessary.
Accesses available resources, such as the patient accounting system, biller files, other areas in the Revenue Cycle, or payer databases, to locate missing or incorrect information.
Applies creative problem-solving skills in order to overcome obstacles and resolve errors for claim adjudication.
Coordinates with management and external departments to resolve unresolved accounts and potentially create process redesign initiatives for long term root cause resolution.
Completes special projects as assigned.
Maintains a comprehensive awareness of all insurance company updates including Federal and State guidelines.
Meets productivity goals as assigned by the Revenue Cycle Director.