Patient Financial Services Follow-Up Representative, Revenue Cycle

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🔥 17 hours ago

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Mercyhealth Wisconsin and Illinois

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1889

⚕️ Healthcare Insurance

📚 Education

Healthcare Insurance • Education

Mercyhealth Wisconsin and Illinois is a regional integrated health system providing hospitals, outpatient clinics, urgent care, specialty care (cardiology, oncology, orthopedics, neurosurgery, etc. ), pharmacies, home health and hospice services across northern Illinois and southern Wisconsin. It operates MercyCare Health Plans (commercial health insurance), offers graduate medical education and fellowship/residency programs, runs a foundation and community health initiatives, and provides patient-facing resources such as MyChart, online scheduling, and wellness programs.

📋 Description

• 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. • 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. • 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. • 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. • 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. • 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.

🎯 Requirements

• High school diploma or equivalent • Microsoft Excel required • Healthcare billing experience preferred • Basic understanding of working in multiple software applications at the same time

🏖️ Benefits

• 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