Mercyhealth Wisconsin and Illinois · 4 weeks ago
Financial Resource Specialist 1
Lake Geneva, WI
Full-time
Onsite
Entry Level
2+ years expMercyhealth Wisconsin and Illinois is seeking a Financial Resource Specialist who will be responsible for ensuring adherence to financial policies and assisting patients with their insurance and financial concerns. The role involves extensive knowledge of billing, collections, and financial resources available to patients, as well as direct interaction with patients to address their financial responsibilities and assist with eligibility processes.
Health CareNon Profit
Responsibilities
Follows and administers all Mercyhealth financial policies and guidelines. In-depth knowledge of collection laws, an understanding of statement cycles, and the bad debt process
Maintains a thorough knowledge base of the registration and cash drawer process
Follows all necessary frontline workflows in regard to payment posting, cash drawer balancing and adheres to all cash compliance policies
Researches and performs audits on patient accounts to determine where balances are due, from third party payers or patient responsibility
Meets with patients in person or via telephone to counsel patients/customers on billing concerns, account balances, services costs/estimates, and various insurance resources
Establishes payment plans with patients and follows up on broken payment arrangements when appropriate
Researches patient accounts, processes refunds, and pay in full discounts
Communicates with physicians, patient care staff and hospital/clinic reception regarding out of network insurance status, medical urgency, and other patient billing/ insurance issues
Thorough understanding of how to identify if charges are correct
In depth understanding of what information is available to assist in the process, such as the medical record, chart view, MPI, billing, and coding reviews as appropriate
Navigates the billing system and review patient accounts for accuracy
Initiates appropriate follow-up with patients, billing department, coding department, and insurance companies to ensure payment for services
Familiar with managed care contract reimbursement rates
Understands terminology associated with contracts as well as familiar with terminology and calculations used on a payment voucher and patient's explanation of benefits
Understands Governmental and Commercial insurance reimbursement rates
Maintains an extensive knowledge base of programs offered through the government, the insurance marketplace, Care Credit, foundation grants, and other financial resource options
Assists 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
Initiates appropriate follow-up with patients, insurance companies or billing department to ensure payment for services
Completes insurance eligibility, benefit verification and pre-certifications as required
Monitors 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
Sends stat requests to appropriate department and with the partner as needed to resolve patient issues/questions
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 patient, payors, and Mercyhealth partners
Meets 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
Researches 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
Uses good judgments in highly emotional and demanding situations
Reacts to frequent changes in duties and volume of work
Manages multiple tasks with ease and efficiency
Works independently with minimal supervision and be result oriented
Effective interpersonal skills, including the ability to promote teamwork
Ensures a high level of customer satisfaction including employees, patients, visitors, physicians, and external stakeholders
Provide training and mentoring
Participates in educational programs to meet mandatory requirements and identified needs with regard to position and personal growth
Performs other duties as assigned
Qualification
Required
Extensive knowledge of Mercyhealth financial guidelines, collection policies, and government regulations related to billing and collections
Ability to greet patients or family members in various clinic and hospital settings
Knowledge of all aspects of the revenue department from the registration process through the collection, billing, coding, and denial process
Extensive knowledge base of all community, state, or federal government programs to provide assistance to patients who have no or limited ability to pay for their health care
Comprehensive knowledge base of alternative financial resources to counsel and educate patients on all available financial resource options
Ability to assist patients and family members with the Presumptive Eligibility process
Ability to follow up with patients to ensure they have secured a financial resource in place to pay for their health care
Ability to prepare complex estimates for services and counsel patients on their expected personal financial responsibility
Ability to keep up to date with insurance plans and payers to appropriately counsel patients on their health care financial responsibilities
Ability to work with patients and their insurance companies to resolve complicated billing and denial issues
In-depth knowledge of collection laws, understanding of statement cycles, and the bad debt process
Thorough knowledge base of the registration and cash drawer process
Ability to follow all necessary frontline workflows in regard to payment posting, cash drawer balancing and adherence to all cash compliance policies
Ability to research and perform audits on patient accounts to determine where balances are due, from third party payers or patient responsibility
Ability to meet with patients in person or via telephone to counsel patients/customers on billing concerns, account balances, services costs/estimates, and various insurance resources
Ability to establish payment plans with patients and follow up on broken payment arrangements when appropriate
Ability to research patient accounts, process refunds, and pay in full discounts
Ability to communicate with physicians, patient care staff and hospital/clinic reception regarding out of network insurance status, medical urgency, and other patient billing/insurance issues
Thorough understanding of how to identify if charges are correct
In-depth understanding of what information is available to assist in the process, such as the medical record, chart view, MPI, billing, and coding reviews as appropriate
Ability to navigate the billing system and review patient accounts for accuracy
Ability to initiate appropriate follow-up with patients, billing department, coding department, and insurance companies to ensure payment for services
Familiarity with managed care contract reimbursement rates
Understanding of terminology associated with contracts as well as familiarity with terminology and calculations used on a payment voucher and patient's explanation of benefits
Understanding of Governmental and Commercial insurance reimbursement rates
Maintains an extensive knowledge base of programs offered through the government, the insurance marketplace, Care Credit, foundation grants, and other financial resource options
Ability to assist patients in obtaining copay and drug replacement assistance for services provided
Ability to screen patients in need and provide assistance with completion of the charity care application process
Ability to screen self-pay patients for presumptive eligibility for Medicaid and perform necessary follow-up to ensure coverage is in place
Ability to complete insurance eligibility, benefit verification and pre-certifications as required
Ability to monitor patient work queues and resolve outstanding balance issues
Ability to contact patients with self-pay balances to collect payment, set payment arrangements, or provide assistance with financial resources
Ability to respond to patient inquiries via in person, mail, phone, and/or email
Ability to send stat requests to appropriate department and with the partner as needed to resolve patient issues/questions
Ability to respond to third party and patient requests on credit balances and initiate refund process in the event monies are due back to the payer or patient
Ability to act as a liaison between the patient, payors, and Mercyhealth partners
Ability to meet Patient Access department guidelines for daily patient contact, collection goals, and department benchmarks
Ability to follow documentation standards on all patient encounters on appropriate patient account/claim utilizing notes
Ability to perform high level service recovery to resolve patient concerns
Ability to manage complaints and grievances and follow through until resolution is in place
Ability to research denied claims through review of system/account/process to reconcile information
Ability to manage access to multiple insurance websites to assist patients with billing, claim, and denial concerns
Ability to use good judgments in highly emotional and demanding situations
Ability to react to frequent changes in duties and volume of work
Ability to manage multiple tasks with ease and efficiency
Ability to work independently with minimal supervision and be result oriented
Effective interpersonal skills, including the ability to promote teamwork
Ability to ensure a high level of customer satisfaction including employees, patients, visitors, physicians, and external stakeholders
Ability to provide training and mentoring
Participation in educational programs to meet mandatory requirements and identified needs with regard to position and personal growth
Preferred
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
Benefits
Comprehensive Benefits Package: Mercyhealth offers a retirement plan with competitive matching contribution, comprehensive medical, dental, and vision insurance options, life and disability coverage, access to flexible spending plans, and a variety of other discounted voluntary benefit options.
Competitive Compensation: Mercyhealth offers market competitive rates of pay and participates in various shift differential and special pay incentive programs.
Paid Time Off: Mercyhealth offers a generous paid time off plan, which increases with milestone anniversaries, to allow employees the opportunity for a great work-life balance.
Career Advancement: Mercyhealth offers a number of educational assistance programs and career ladders to support employees in their educational journey and advancement within Mercyhealth.
Employee Wellbeing: Mercyhealth has a focus on wellbeing for employees across the organization and offers a number of tools and resources, such as an employer-sponsored health risk assessment and a Wellbeing mobile application, to assist employees on their wellbeing journey.
Additional Benefits: Mercyhealth employees have access to our internal and external employee assistance programs, employee-only discount packages, paid parental and caregiver leaves, on-demand pay, special payment programs for patient services, and financial education to help with retirement planning.
Company
Mercyhealth Wisconsin and Illinois
At Mercyhealth, our doctors, nurses and staff are committed to making lives better for our patients and their families.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Nathan Schultz
Chief Technology Officer
Shawn David
Chief Technology Officer / Chief Security Officer IMS Technical Director
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