Mercyhealth Wisconsin and Illinois

Insurance Billing Representative, Patient Accounts

Mercyhealth Wisconsin and Illinois

full-time

Posted on:

Location Type: Remote

Location: Illinois • United States

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Salary

💰 $18 - $27 per hour

About the role

  • 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.

Requirements

  • 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.
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.
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
claims verificationclaim adjustment reason codesdenial reviewappeal draftingmedical records managementbilling accuracy reviewaccount balance resolutionbilling functionsproblem-solvingprocess redesign
Soft Skills
communicationinterpersonal skillstrainingguidance seekingcreative problem-solvingself-developmenttimelinesstrend identificationescalationcollaboration