Financial Resource Specialist

Essential Duties and Responsibilities

• Follows and administers all Mercyhealth financial policies and guidelines. In-depth knowledge of collection laws, an understanding of statement cycles, and the bad debt process.
• Maintains a thorough knowledge base of the registration and cash drawer process.
• Follows all necessary frontline workflows in regard to payment posting, cash drawer balancing and adheres 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.
• Meets with patients in person or via telephone to counsel patients/customers on billing concerns, account balances, services costs/estimates, and various insurance resources.
• Establishes payment plans with patients and follows up on broken payment arrangements when appropriate.
• Researches patient accounts, processes refunds, and pay in full discounts.
• Communicates 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, chart view, MPI, billing, and coding reviews as appropriate.
• Navigates the billing system and reviews patient accounts for accuracy.
• Initiates appropriate follow-up with patients, 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.
• Maintains an extensive knowledge base of programs offered through the government, the insurance marketplace, Care Credit, foundation grants, and other financial resource options.
• Assists 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 pre-certifications as required.
• Monitors patient work queues and resolves 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 patient, payors, and Mercyhealth partners.
• Meets 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.
• Researches denied claims through review of system/account/process to reconcile information. Manages access to multiple insurance websites to assist patients with billing, claim, and denial concerns.
• Uses good judgments in highly emotional and demanding situations.
• Reacts to frequent changes in duties and volume of work.
• Manages multiple tasks with ease and efficiency.
• Works independently with minimal supervision and be result oriented.
• Effective interpersonal skills, including the ability to promote teamwork.
• Ensures a high level of customer satisfaction including employees, patients, visitors, physicians, and external stakeholders.
• Provide training and mentoring.
• Participates in educational programs to meet mandatory requirements and identified needs with regard to position and personal growth.
• Performs other duties as assigned.

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…