OVERVIEW: Experienced healthcare revenue cycle professional with expertise in claims processing, billing, coding, payer regulations, and reimbursement. Skilled in Epic/Brightree, denial resolution, EOBs, payer portals, and collections, with a strong ability to independently resolve complex billing issues and maintain accurate, timely accounts.
40-hours per week
AND RESPONSIBILITIES Processes claims on a daily basis by demonstrating in-depth knowledge of billing procedures by payer and ensures claims being worked remain timely per department standards. Understands Epic/Brightree billing edits used to stop a claim from being transmitted electronically and understands how to research information as needed to correct the claim Maintains in-depth knowledge of all Federal and State regulations to ensure all claims billed to Medicare and Medicaid are correct and that issues resulting in inaccurate claims are brought to the attention of the supervisor.
Is knowledgeable of CPT/HCPC coding and use of modifiers in payment determinations. Understands various managed care reimbursement methodologies related to department payment Collects and enters information relating to patient accounts in a timely manner and ensures Epic/Brightree system is updated to accurately reflect the current status of patient accounts. Understands computer system processing to identify possible processing errors and establishes contacts at the payors to resolve contract issues.
Ensures all insurance related mail/correspondence is worked and remains current Prioritizes work effectively to prevent backlogs and ensures follow-up is done on all accounts/claims on their worklist on a daily/weekly basis, ensuring that all claims/accounts have no follow-up dates that fall into previous months and notifies supervisor of any backlogs. Works independently to identify and resolve claim denials and rejections.
Understands and navigates payer portals, websites and manuals. Interprets and post EOBs. Investigates and resolves patient inquiries.
Performs all functions related to the collection of delinquent accounts, including follow up phone calls, resubmission of claims to third party payers, collections letters, and processing accounts for collection agencies. CULTURE OF EXCELLENCE BEHAVIOR EXPECTATIONS To perform the job successfully, an individual should demonstrate the following behavior expectations: Quality - Follows policies and procedures; adapts to and manages changes in the environment; Demonstrates accuracy and thoroughness giving attention to details; Looks for ways to improve and promote quality; Applies feedback to improve performance; Manages time and prioritizes effectively to achieve organizational goals.
Service - Responds promptly to requests for service and assistance; Follows the Mercyhealth Critical Moments of service; Meets commitments; Abides by MH confidentiality and security agreement; Shows respect and sensitivity for cultural differences; and effectively communicates information to partners; Thinks system wide regarding processes and functions. Partnering - Shows commitment to the Mission of Mercyhealth and Culture of Excellence through all words and actions; Exhibits objectivity and openness to other's views; Demonstrates a high level of participation and engagement in day-to-day work; Gives and welcomes feedback; Generates suggestions for improving work: Embraces teamwork, supports and encourages positive change while giving value to individuals.
Cost - Conserves organization resources; Understands fiscal responsibility; Works within approved budget; Develops and implements cost saving measures; contributes to profits and revenue. EDUCATION AND EXPERIENCE High school diploma or general education degree (GED) ADDITIONAL REQUIREMENTS Passing the Driver’s License Check and/or Credit Check (for those positions requiring). Passing the WI Caregiver Background Check and/or IL Health Care Workers Background Check.
Must be able to follow written/oral instructions. OTHER SKILLS AND ABILITIES Language Skills Ability to read and comprehend simple instructions, short correspondence, and memos. 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 bar graphs. Reasoning Ability Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.
Computer Skills To perform this job successfully, an individual should have knowledge of Accounting software; Spreadsheet software and Word Processing software. Basic understanding of where and which system houses information, understands the relationship between systems and what purpose each system serves. WORK ENVIRONMENT The noise level in the work environment is usually quiet Occupational Exposure: Category C - No partners in the specified job classification have occupational exposure.
AGE OF PATIENTS SERVED Non-Specific Task (not applicable) INFORMATION ACCESS Partner may access patient care information needed to perform their job duties. WORK CONTACT GROUP Partners, physicians, patients/family, visitors, vendors SPECIAL PHYSICAL DEMANDS The Special Physical Demands are considered Essential Job Functions of the position with or without reasonable accommodations. While performing the duties of this job, the employee is frequently required to sit; Prolonged sitting. handle, finger, feel, reach, talk and hear.
The employee is occasionally required to stand, walk, stoop, kneel, crouch and crawl. Medium work exerting 10 to 25 lbs of force or lifting occasionally. Specific vision abilities required by this job include frequent close vision and ability to adjust focus and occasional distance vision.
Manual dexterity needed to operate telephone and keyboard. LEVEL OF SUPERVISION Work requires a moderate level of independent judgment along with good interpretive and interpersonal skills with justification and accountability to department leadership
$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. 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