Financial Resource Specialist 1

ESSENTIAL DUTIES AND 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.

EDUCATION AND/OR EXPERIENCE

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.

CERTIFICATION/LICENSURE

N/A

OTHER SKILLS AND ABILITIES
Excellent oral and written communication skills/organizational skills.
Strong problem-solving skills.
Knowledge of various health care systems and databases desirable.
Knowledge of general computer applications (word, excel, outlook, etc.)
Ability to multitask and prioritize tasks accordingly
Ability to handle challenging conversations professionally

Language Skills
Ability to read and interpret documents such as emails, insurance documents, guidelines, instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak and communicate effectively with customers and other partners. Ability to speak Spanish desirable.

Mathematical Skills
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret basic graphs.

Reasoning Ability
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.

Computer Skill
To perform this job successfully, an individual should have knowledge of general computer applications. Database software, payor sites for claims and authorization statuses, and eligibility software, and Microsoft Office Suite (primarily Word and Excel). Must be able to multitask and toggle between screens, document in different systems timely, thoroughly, and efficiently.

LEVEL OF SUPERVISION

Some independent judgment is required, but alternatives are limited by standard practices or procedures.

SUPERVISES

There are no supervisor responsibilities for this position.

PAY RANGE:

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.

Mercyhealth has been nationally recognized for our commitment to our people and culture, including:

• #1 in the nation on AARP's Best Employers for Workers Over 50

• One of Working Mother magazine's 100 Best Companies for Working Mothers

• A Top 50 Company and Top 10 Nonprofit for Executive Women