Patient Financial Services Follow Up 1

Mercyhealth Wisconsin and Illinois•Home, WV

2d•$18 - $27•Onsite

About The Position

This role is responsible for verifying claim receipt by payers, following up on payments via phone, portal, or website, and reviewing claim adjustment reason codes and explanations of benefits to determine reasons for denials. The position involves evaluating next steps after denial review, taking action to call payers, resubmit claims, or file disputes/appeals/reconsiderations as required. It also includes drafting appeals, completing reconsideration forms, and obtaining/sending medical records when necessary to substantiate medical necessity. The role requires reviewing billing forms for accuracy, contacting patients or payers directly to resolve account balances, identifying trends in payor rejections/denials, and escalating these trends to leads/supervisors. The position utilizes computer systems to locate claim information, maintains compliance with patient financial services policies, and uses office equipment. It involves reviewing accounts based on inquiries, working with other departments to resolve outstanding questions, and interacting with other Patient Financial staff for information sharing and guidance. The role also includes researching and appealing denied claims for no authorization, escalating high dollar accounts, reporting equipment malfunctions, and accessing various resources to resolve errors. Coordination with management and external departments for unresolved accounts and process redesign is also part of the role, along with completing special projects and maintaining awareness of insurance company updates and guidelines. Finally, the position requires meeting productivity goals.

Requirements

High school diploma or equivalent.
Microsoft Excel required.
Basic understanding of working in multiple software applications at the same time.
Basic business writing skills.
Should understand how to work with others to impact change.

Nice To Haves

Healthcare billing experience preferred.

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 what reasons for denials records are indicating for 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 in a format that is logical and relates to the open denial of payment.
Obtains and sends medical records during the appeals process when needed to substantiate medical necessity.
Reviews billing forms for both paper submissions and electronic submissions for accuracy.
Calls patients or payers directly without hesitation to obtain needed information to resolve an account balance when applicable.
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 at a higher level that are 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.