Mercyhealth

Integrated health system delivering coordinated care

Financial Resource Specialist

Clinical Support & Patient AdministrationPosted on Nov 12

Full-timeRockford, IL, USA$18.65 - $27.97In-person

About the Job

Requirements

Two years of customer service and/or collections experience.
Knowledge of reimbursement practices for commercial and government payers is preferred.
Medical terminology is preferred.
Ability to read and interpret emails, insurance documents, guidelines, instructions, and procedure manuals.
Ability to write routine reports and correspondence and communicate effectively with customers and other partners.
Ability to add, subtract, multiply, and divide using whole numbers, common fractions, and decimals, and to compute rates, ratios, and percentages and interpret basic graphs.
Ability to apply common-sense understanding to written, oral, or diagrammed instructions and address problems involving several concrete variables in standardized situations.
Knowledge of general computer applications, including Microsoft Word, Excel, and Outlook; database software; payer sites for claims and authorization statuses; eligibility software; and Microsoft Office Suite, primarily Word and Excel.
Ability to multitask, prioritize tasks, toggle between screens, and document thoroughly and efficiently across different systems.
Ability to handle challenging conversations professionally.
Ability to work independently with minimal supervision and exercise judgment within standard practices and procedures.
Effective interpersonal skills, including the ability to promote teamwork.

Responsibilities

Administer financial policies and guidelines, applying knowledge of collection laws, statement cycles, and the bad debt process.
Maintain knowledge of registration and cash drawer processes, frontline workflows for payment posting, cash drawer balancing, and cash compliance policies.
Research and audit patient accounts to determine whether balances are due from third-party payers or are the patient's responsibility.
Meet with patients in person or by telephone to discuss billing concerns, account balances, service costs and estimates, and insurance resources.
Establish payment plans and follow up on broken payment arrangements when appropriate.
Research patient accounts, process refunds, and apply pay-in-full discounts.
Communicate with physicians, patient care staff, and hospital or clinic reception regarding out-of-network insurance status, medical urgency, and patient billing or insurance issues.
Identify whether charges are correct and use available information, including medical records, chart views, MPI, billing, and coding reviews, as appropriate.
Navigate the billing system and review patient accounts for accuracy.
Follow up with patients, billing and coding departments, and insurance companies to ensure payment for services.
Apply knowledge of managed-care contract reimbursement rates and contract terminology, as well as payment voucher and explanation-of-benefits terminology and calculations.
Maintain knowledge of government and commercial insurance reimbursement rates and financial resource programs, including government programs, the insurance marketplace, Care Credit, foundation grants, and other options.
Assist patients in obtaining copay and drug replacement assistance for services provided.
Screen patients in need and assist with completion of charity care applications.
Screen self-pay patients for presumptive Medicaid eligibility and follow up to ensure coverage is in place.
Complete insurance eligibility checks, benefit verification, and precertifications as required.
Monitor patient work queues and resolve outstanding balance issues.
Contact patients with self-pay balances to collect payments, arrange payment plans, or provide financial-resource assistance.
Respond to patient inquiries in person, by mail, by phone, and by email.
Send urgent requests to the appropriate department and coordinate with partners as needed to resolve patient issues and questions.
Respond to third-party and patient requests regarding credit balances and initiate refunds when money is owed to the payer or patient.
Act as a liaison between patients, payers, and Mercyhealth partners.
Meet Patient Access department guidelines for daily patient contacts, collection goals, and department benchmarks.
Document all patient encounters in the appropriate patient account or claim and keep account status accurate and current.
Resolve patient concerns through service recovery, manage complaints and grievances, and follow through to resolution.
Research denied claims by reviewing systems, accounts, and processes; use multiple insurance websites to help patients with billing, claims, and denial concerns.
Use sound judgment in emotional and demanding situations, respond to frequent changes in duties and workload, and manage multiple tasks efficiently.
Provide training and mentoring.
Participate in educational programs to meet mandatory requirements and identified position and personal-growth needs.
Perform other duties as assigned.

Desired Qualifications

Knowledge of reimbursement practices for commercial and government payers.
Medical terminology.
Knowledge of various healthcare systems and databases.
Ability to speak Spanish.

OVERVIEW

Help patients understand and manage their healthcare bills by reviewing accounts, explaining insurance coverage, setting up payment plans, and connecting patients with financial assistance resources. This role works closely with patients, insurance companies, and healthcare teams to resolve billing concerns, ensure accurate payments, and provide excellent customer service in a fast-paced healthcare environment.

SCHEDULE: 40-hours per week
SHIFT: Days

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:

$18.65 - $27.97

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

About the Company

Mercyhealth

Integrated health system delivering coordinated care

Mercyhealth is an integrated health system offering hospital-based, clinic-based, and post-acute and retail health services, plus its own insurance company. Patients access care within a connected network where doctors, nurses, and staff coordinate across settings to ensure smooth transitions and better outcomes. It differentiates itself by providing a fully integrated experience—clinical care linked with an owned insurance plan—that enables coordinated treatment and consistent care close to home. Its goal is to deliver exceptional health care and make lives better for patients and families by improving access, outcomes, and the patient experience through end-to-end integration.

Company size: 1,001-5,000
Company stage: Not listed
Total funding: Not listed
Headquarters: Rockford, IL
Founded: Not listed

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