PFS Specialty Group Representative -Day Shift

Mercy Health Corporation

Janesville (WI)

Hybrid

USD 25,000 - 39,000

Full time

6 days ago

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Benefits offered by this job

Medical, Dental, Vision

Life & Disability Insurance

Paid time off

Parental and caregiver leave

Tuition reimbursement

Well-being Programs

Employee Discounts

On-Demand Pay

Job summary

Mercyhealth is seeking an experienced Patient Financial Services professional to audit, bill, and resolve complex claims within the Epic SBO environment. You will handle workers' compensation, third-party liability, denials, and refunds, while maintaining HIPAA compliance and high productivity in a hybrid setting.

In this role you’ll collaborate with payer, patient, and attorney offices, review documentation, and advance accounts through the revenue cycle from intake to payment, ensuring

Qualifications

High school diploma or equivalent.
Microsoft Excel required and healthcare billing experience preferred.
2 - 3 years customer service experience preferred or 1 year customer service in medical field preferred.
Ability to work with multiple software applications simultaneously.
Basic understanding of working in hospital/clinic billing environments.

Responsibilities

Research and perform audits on patient accounts to ensure correct payer billing.
Identify if charges on a patient’s account are correct using available information such as medical records and charts.
Understand collection laws for workers' compensation and third party liability.
Learn and operate Epic SBO environment and related applications.
Respond to inquiries from patients, insurers, and outside vendors via mail, phone, or email.
Verify claims received by payers and follow up to obtain payment.
Draft appeal letters as needed and escalate as necessary.

Skills

Account auditing

Denial resolution

HIPAA compliance

Team collaboration

Attention to detail

Customer service

Epic SBO

Education

High school diploma or equivalent

Tools

Epic

Agility

Connex

Kronos

OneSource

MS Word

MS Outlook

Claim Source

On-Base

Job description

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: