Patient Access Specialist

Mercy-Health-System-Corporation; Janesville (WI); On-site; USD 29,000 - 43,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Life & Disability Insurance

FSA/HSA Options

Paid time off

Parental leave

Tuition reimbursement

Certification reimbursement

Well-being Programs

Employee Discounts

On-Demand Pay

Recognition events

Career advancement opportunities

Job summary

Mercyhealth is seeking a Revenue Cycle/Patient Access professional to research payer denials, initiate appeals, and obtain financial resolution for services. The role emphasizes compliance with Medicare, Medicaid, and Mercyhealth policies while maintaining patient confidentiality.

Responsibilities include referrals/authorizations, training teammates, and contributing to a high-quality patient experience across Mercyhealth’s Wisconsin and Illinois footprint.

Qualifications

• High school diploma or equivalent preferred.
• Two years of customer service or healthcare registration experience preferred.
• Knowledge of Medicare/Medicaid guidelines is beneficial.

Responsibilities

• Research payer denials related to referrals, pre-authorization, and medical necessity.
• Initiate appeals with insurers and submit detailed customized appeals.
• Maintain compliance with HIPAA and patient confidentiality.
• Provide training to new partners and support revenue cycle activities.

Skills

Customer service

Healthcare registration

Scheduling

HIPAA knowledge

Education

High school diploma or equivalent

Healthcare revenue cycle certification

Job description

ESSENTIAL DUTIES AND RESPONSIBILITIESResearch payer denials related to referral, pre-authorization, medical necessity, case management, non-covered services, and billing resulting in denials and delays in payment. Initiate appeals with insurers appropriately.Submit detailed, customized appeals to payers based on review of medical records and in accordance with Medicare, Medicaid, and third-party guidelines as well as Mercyhealth Revenue Cycle policies and proceduresIdentify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up, and/or root cause resolutionInitiates, obtains, and documents referrals/authorizations/pre-certifications in appropriate systems.Ensures compliance with Access and Revenue Cycle related policies and procedures.Completes accounts in assigned work queues.Maintains a high level of professionalism and provides a quality patient experience.Ensures compliance with reporting related to demographics and federal and state requirements.Contacts insurance companies or employer groups via phone, web portals, electronic applications, or other appropriate means to determine eligibility and benefits for necessary services to obtain financial resolution and payment on account.Maintains current knowledge of payor payment provisions and regulations to ensure correct data is gathered and documented.Documents activity within appropriate EMR or patient accounting systems.Demonstrates an understanding and follows patient confidentiality policies and all HIPAA Regulations.Performs other clerical duties as needed such as faxing, filing and photocopying.Subject matter expert with regards to assigned responsibilities.Provides training to new partners, as well as on an as-needed basis.Ensures compliance with Patient Access and Revenue Cycle related policies and procedures.Reviews external orders/referrals to ensure authorization and compliance requirements are met.Manages other duties as assigned.EDUCATION AND/OR EXPERIENCE•High school diploma or equivalent preferred.•Two years of customer service experience preferred.•Two years of healthcare registration, scheduling, or physicians' office experience required.CERTIFICATION/LICENSUREHealthcare revenue cycle related certification or an equivalently designated certification approved by management required within 1 year of hire.PAY RANGE:$21.00 - $31.50Mercyhealth 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, VisionLife & Disability InsuranceFSA/HSA OptionsGenerous, accruing paid time offPaid Parental and caregiver leaveCareer advancement and educational opportunitiesTuition and certification reimbursementCertification ReimbursementWell-being ProgramsEmployee DiscountsOn-Demand PayFinancial EducationAnnual recognition/awards eventsPartner appreciation daysFamily entertainment/attractions discountCommunity service/improvement opportunitiesClick 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 50One of Working Mother magazine's 100 Best Companies for Working MothersA Top 50 Company and Top 10 Nonprofit for Executive Women