PFS Specialty Group Representative -Day Shift

Mercy-Health-System-Corporation; Janesville (WI); Hybrid; USD 25,000 - 39,000; Full time

Benefits offered by this job

Medical, Dental, Vision

Life & Disability Insurance

Paid time off

Parental and caregiver leave

Tuition reimbursement

Employee Discounts

Job summary

Mercyhealth in Wisconsin is seeking a Patient Financial Services professional to audit and resolve patient accounts, focusing on payer accuracy and timely billing. You will work in a hybrid schedule and handle SBO and Epic workflows with strong attention to HIPAA, privacy, and compliance.

The role emphasizes Excel-based data entry, denials management, and coordination with payers, attorneys, and patients to resolve balances and refunds as needed.

Qualifications

• Auditing patient accounts for correct payer billing.
• Understand collection laws for workers' compensation and third party liability.
• Becomes fluent in the Single Billing Office environment within Epic SBO.
• Know SBO billing practices and hospital/clinic billing requirements.
• Respond to inquiries from patients, payers, attorneys, and vendors.

Responsibilities

• Research and perform audits on patient accounts to verify correct balances and payer assignments.
• Identify and resolve denials and disputed claims with payers.
• Draft appeal letters per payer requirements when needed.
• Obtain medical records as required for workers' compensation and TPL claims.
• Maintain HIPAA compliance and document all encounters accurately.

Skills

Microsoft Excel

Healthcare billing

Typing / data entry

Organizational skills

Customer service

Medical terminology

Education

High school diploma or equivalent

Tools

Epic SBO

Agility

Connex

Kronos

OneSource

Microsoft Word

Microsoft Outlook

Claim source

On-Base

Job description

OVERVIEWExperienced 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 weekSHIFT: Hybrid, Flexible Schedule between 7:00am-6:00pmESSENTIAL DUTIES AND RESPONSIBILITIESResearch 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 EpicMaintains 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 endLearn 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 involvedResponds 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 assignedVerifies 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 situationsMaintains productivity standards as outlined in the Revenue Cycle departmentEDUCATION AND/OR EXPERIENCEHigh school diploma or equivalentMicrosoft 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/LICENSUREN/AOTHER SKILLS AND ABILITIESProven 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 SUPERVISIONN/ASUPERVISESN/APAY RANGE:$17.92 - $27.97Mercyhealth 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