Mercyhealth

Integrated health system delivering coordinated care

Patient Financial Services Specialty Group Representative

Clinical Support & Patient AdministrationConfirmed live in the last 24 hours

Full-timeJanesville, WI, USA$17.92 - $27.97

About the Job

Requirements

High school diploma or equivalent.
Microsoft Excel is required.
Basic understanding of working in multiple software applications at the same time.
Strong typing and data-entry experience.
Strong organizational skills and attention to detail, accuracy, and follow-through.
Ability to adapt to change in a positive, sensitive, and forward-thinking manner in demanding situations.
Ability to work effectively in a team environment.

Responsibilities

Research and audit patient accounts to determine whether balances are billed to the correct payer.
Determine whether charges on patient accounts are correct and use available information, including medical records, chart view, and MPI, to support account review.
Apply collection laws pertaining to workers' compensation and third-party liability claims.
Become fluent and knowledgeable in the Single Billing Office environment within Epic.
Maintain working knowledge of common billing and account-resolution practices and requirements for hospital and/or clinic billing.
Work claims from beginning to end.
Learn and develop in-depth knowledge of applications used by Patient Financial Services partners, including Epic, Agility, Connex, Kronos, OneSource, Microsoft Word, Microsoft Outlook, ClaimSource, and OnBase.
Identify the correct filing order according to department processes when multiple insurances are involved.
Respond to inquiries from patients, insurance companies, attorney offices, and outside vendors via mail, phone, or email.
Respond to credit-balance inquiries for workers' compensation, third-party liability, hospice, skilled nursing facility, and occupational health accounts, and initiate refunds when money is due to the payer or patient.
Respond to billing reviews and inquiries from other Patient Financial Services groups, including billing, follow-up, cash posting, and customer service.
Document encounters in the appropriate patient account or claim using notes and keep accounts updated to accurately reflect their current status.
Protect the privacy and confidentiality of customers, patients, and partners in accordance with Mercyhealth policies, its Code of Ethics, and HIPAA laws.
Review workers' compensation, third-party liability, and personal-injury settlement requests before sending them to the supervisor.
Work on special projects and perform other assigned duties.
Verify that payers receive claims and follow up to obtain payment by phone, portal, or website.
Review failed claims and resolve disputed and denied claims.
Obtain and send medical records as needed for workers' compensation claims, third-party liability accounts, and attorney offices.
Draft appeal letters in the required format based on payer requirements and the denied claim.
Become familiar with ICD-10, CPT, and/or HCPCS coding systems, claim forms such as CMS-1500 and UB-04, and payer remittances.
Call patients, payers, and attorney offices to obtain information needed to resolve account balances.
Identify trends in payer denials and escalate them to leads or supervisors.
Work with appropriate revenue cycle staff when performing account-resolution functions.
Work assigned work queues, reports, and spreadsheets.
Participate in department meetings, workgroup meetings, and training sessions.
Maintain productivity standards established by the Revenue Cycle department.

Desired Qualifications

Healthcare billing experience is preferred.
Two to three years of customer service experience is preferred, or one year of customer service experience in a medical field is preferred.
Knowledge of medical terminology is preferred.
Undertake self-development activities.

OVERVIEW

Experienced Patient Financial Services and Revenue Cycle professional with expertise in account auditing, insurance billing, denial resolution, and complex claims management. Proficient in Epic SBO and healthcare revenue cycle systems, with a strong background in Workers' Compensation, Third-Party Liability, appeals, and reimbursement processes. Skilled at collaborating across teams, ensuring HIPAA compliance, and delivering accurate, timely account resolution while consistently meeting productivity goals.

SCHEDULE: Full -Time, 40 hours per week

SHIFT: Hybrid, Flexible Schedule between 7:00am-6:00pm

ESSENTIAL DUTIES AND RESPONSIBILITIES

Research and preform audits on patient accounts to determine balances are being billed to the correct payer.
Thorough understanding of how to identify if charges on a patient's account are correct. In depth understanding of what information is available to assist in the process, such as the medical records, chart view, MPI, etc.
In-depth understanding of collection laws pertaining to worker compensation and third party liability claims.
Become fluent and knowledgeable in the Single Billing Office environment within Epic
Maintains a working knowledge of common billing and account resolution practices and requirements for hospital and/or clinic billing (SBO).
Knowledge of how to work a claim from beginning to end
Learn and create in-depth knowledge of all applications used by Patient Financial Services partners such as: Epic, Agility, Connex, Kronos, OneSource, Microsoft Word, Microsoft Outlook, Claim source, On-Base, etc.
Identifies the correct filing order per department processes when multiple insurances are involved
Responds to inquiries from patients, insurance companies, attorney offices and outside vendors via mail, phone and/or email.
Responds to inquiries regarding credit balances on Workers Compensation, Third Party Liability, Hospice, Skilled Nursing Facilities and Occupational Health accounts and initiates the refund process in the event monies are due back to the payer or patient.
Responds to Billing reviews/ inquiries from other PFS groups such as Billers, Follow-up, Cash posting and Customer Service.
Documents all encounters on appropriate patient account/claim utilizing notes. Ensures account is updated to accurately reflect the current status.
Protects privacy and confidentiality of customers, patients and partners in accordance with Mercyhealth policies, the Code of Ethics and HIPAA laws.
Review all Work Comp, TPL and personal injury settlement requests before sending them to the Supervisor.
Work special projects and other job duties as assigned
Verifies claims are received by the payer and follows up to obtain payment via phone calls, portal or websites.
Reviews failed claims, resolves disputed and denied claims.
Obtains and sends medical records as needed for Workers Compensation claims, Third Party Liability accounts and attorneys' offices.
Drafts appeal letters when applicable based on payer requirement in a format that is legible and relates to the denied claim.
Become familiar with ICD-10, CPT, and/or HCPCS Coding Systems as well as claim forms such as CMS-1500 and UB-04 as well as payer remittances.
Calls patients, payers and attorney offices without hesitation to obtain needed information to resolve account balances.
Identify trends with payer denials and escalates these trends to leads/supervisors.
Works with appropriate revenue cycle staff when performing account resolution functions.
Responsible to work assigned work queues, reports and spreadsheets.
Participate in department meetings, workgroup meetings, and training sessions.
Ability to adapt to change in a positive, sensitive and forward-thinking manner in demanding situations
Maintains productivity standards as outlined in the Revenue Cycle department

EDUCATION AND/OR EXPERIENCE

•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.
•2 - 3 years customer service experience preferred or 1 year customer service in medical field preferred.

CERTIFICATION/LICENSURE

N/A

OTHER SKILLS AND ABILITIES
Proven ability to work effectively in a team environment.
Strong typing/data entry experience.
Strong organizational skills and attention to detail, accuracy and follow-through.
Knowledge of medical terminology preferred.

LEVEL OF SUPERVISION

N/A

SUPERVISES

N/A

PAY RANGE:

$17.92 - $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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