Financial Resource Specialist 1

Essential Duties and Responsibilities

• Follow and administer all Mercyhealth financial policies and guidelines. In depth knowledge of collection laws, an understanding of statement cycles, and the bad debt process.
• Maintain a thorough knowledge base of the registration and cash drawer process. Follow all necessary frontline workflows in regards to payment posting, cash drawer balancing and adhere 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.
• Meet with patients in person or via telephone to counsel patients/customers on billing concerns, account balances, services costs/estimates and various insurance resources.
• Establish payment plans with patients and follow up on broken payment arrangements when appropriate. Research patient accounts, process refunds and pay in full discounts.
• Communicate 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, chartview, MPI, billing, and coding reviews as appropriate
• Navigate the billing system and review patient accounts for accuracy. Initiates appropriate follow-up with patient, 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.
• Maintain an extensive knowledge base of programs offered through the government, the insurance marketplace, Care Credit, foundation grants, and other financial resource options. Assist 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 precertifications as required.
• Monitor 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 payor, the patients and/or providers.
• Responsible for meeting 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.
• Research 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.
• Ability to use good judgments in highly emotional and demanding situations
• Ability to react to frequent changes in duties and volume of work
• Ability to manage multiple tasks with ease and efficiency
• Ability to work independently with minimal supervision and be result oriented
• Effective interpersonal skills, including the ability to promote teamwork
• Ability to ensure a high level of customer satisfaction including employees, patients, visitors, physicians and external stakeholders
• Provides shadowing and training to new partners as identified by leadership.
• Completes all required educational courses as assigned by leadership
• Performs other duties as assigned.

Culture of Excellence Behavior Expectations

To perform the job successfully, an individual should demonstrate the following behavior expectations:

Quality - Follows policies and procedures; adapts to and manages changes in the environment; Demonstrates accuracy and thoroughness giving attention to details; Looks for ways to improve and promote quality; Applies feedback to improve performance; Manages time and prioritizes effectively to achieve organizational goals.

Service - Responds promptly to requests for service and assistance; Follows the Mercyhealth Critical Moments of service; Meets commitments; Abides by MH confidentiality and security agreement; Shows respect and sensitivity for cultural differences; and effectively communicates information to partners; Thinks system wide regarding processes and functions.

Partnering - Shows commitment to the Mission of Mercyhealth and Culture of Excellence through all words and actions; Exhibits objectivity and openness to other's views; Demonstrates a high level of participation and engagement in day-to-day work; Gives and welcomes feedback; Generates suggestions for improving work: Embraces teamwork, supports and encourages positive change while giving value to individuals.

Cost - Conserves organization resources; Understands fiscal responsibility; Works within approved budget; Develops and implements cost saving measures; contributes to profits and revenue.

Education and Experience

Graduate of high school.
Two to three years customer service and/or collections experience.
Knowledge of reimbursement practices for commercial and government payers.
Medical terminology desired.

Certification and Licensure

N/A

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 to 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.

Special Physical Demands

While performing the duties of this job, the employee is regularly required to walk; use hands to finger, handle, or feel; reach with hands and arms; climb or balance; stoop, kneel, crouch, or crawl; and talk or hear. The employee is frequently required to sit and work at a computer for long periods of time. The employee is occasionally required to stand. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

While performing the duties of this job, the employee must have good manual dexterity to operate keyboard and telephone; repetitive finger/wrist movement associated with use of keyboard; prolonged sitting. The employee must be able to lift or move office related objects.

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.