ESSENTIAL DUTIES AND 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. After denial review, evaluates next steps 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. Ability to review 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. Identify 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. Also, 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. Apply 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.

EDUCATION AND/OR EXPERIENCE

High school diploma or equivalent. Microsoft Excel required and healthcare billing experience preferred. Undertakes self-development activities. Basic understanding of working in multiple software applications at the same time.

CERTIFICATION/LICENSURE N/A OTHER SKILLS AND ABILITIES

Basic business writing skills. Should understand how to work with others to impact change.

LEVEL OF SUPERVISION N/A SUPERVISES

This job has no supervisory responsibilities

PAY RANGE

$17.92 - $26.88 Mercyhealth is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identify, national origin, disability, or protected veteran status. Mercyhealth offers competitive pay and a comprehensive benefits package including: Medical, Dental, Vision Life & Disability Insurance FSA/HSA Options Generous, accruing paid time off Paid Parental and caregiver leave Career advancement and educational opportunities Tuition and certification reimbursement Certification Reimbursement Well-being Programs Employee Discounts On-Demand Pay Financial Education Annual recognition/awards events Partner appreciation days Family entertainment/attractions discount Community service/improvement opportunities Click here for more details regarding Mercyhealth Careers Benefit Information. At Mercyhealth, we don't simply hire people, we empower employee-partners who are passionate about making lives better. As an integrated health system, we deliver exceptional, coordinated across seven hospitals, 85 primary and specialty clinics, and a team of over 7,500 professionals serving northern Illinois and southern Wisconsin. 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