Patient Financial Services Follow Up 1

Mercyhealth Wisconsin and Illinois

20h•Onsite

About The Position

This role is responsible for verifying claim receipt by payers and following up to obtain payment through various channels such as phone calls, portals, or websites. The position involves reviewing claim adjustment reason codes and explanations of benefits to understand denial reasons and determine appropriate follow-up actions. This includes calling payers, resubmitting claims, or initiating disputes/appeals/reconsiderations. The role requires drafting appeals, completing reconsideration forms, and obtaining medical records when necessary to support appeals. Additionally, the position involves reviewing billing forms for accuracy, contacting patients or payers for information to resolve account balances, identifying trends in rejections or denials, and escalating these trends. The role utilizes computer systems to locate claim information, maintains compliance with policies, and uses office equipment. It also involves reviewing accounts based on inquiries, collaborating with other departments, and researching denied accounts, particularly those denied for No Authorization. The position may also handle billing functions, escalate high dollar accounts, report equipment malfunctions, and access various resources to resolve claim adjudication errors. The role requires coordinating with management and external departments for problem resolution and process improvement, completing special projects, staying updated on insurance company changes and guidelines, and 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.
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 completes 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 submissions 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 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.