Insurance Billing Representative, Patient Accounts

Insurance Billing Representative, Patient Accounts

Join to apply for the Insurance Billing Representative, Patient Accounts role at Mercyhealth Wisconsin and Illinois

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Fully remote options for those with experience, or Janesville, WI, or Rockford, IL. Hybrid remote optional as well and a flexible work schedule is available. Mercyhealth does not currently support remote workers with residency in the following states: CA, OH, OR, PA, NJ, NY.

Responsible for ensuring claims are resolved with third‑party payers in a reasonable time frame as defined by Revenue Cycle metrics. This includes working claims that fail payer rejection edits to resolve errors and submit corrected claims, assessing errors, locating information to correct them, and following up on claims for resolution. Works with other areas in the Revenue Cycle to obtain necessary information to correct errors or supply additional data for claim adjudication.

Remains up-to-date on regulatory requirements through informal and formal updates, including self‑study of payer bulletins and guidelines, and performs other duties as assigned.

• Verifies claims are received by the payer and follows up to obtain payment via phone calls, portal or website use.
• Reviews claim adjustment reason codes or explanations of benefits received by the payer to determine the reasons for denial and appropriate follow‑up.
• After denial review, evaluates next steps and takes action to call payer, follow up with a resubmission or dispute/appeal/reconsideration as required by payer, or works internally to receive payment on account.
• Drafts an appeal or complete reconsideration forms when applicable based on payer requirements in a format that is logical and relates to the open denial of payment.
• Obtains and sends medical records during the appeals process when needed to substantiate medical necessity.
• Reviews billing forms for both paper and electronic submissions for accuracy.
• Calls patients or payers directly without hesitation to obtain needed information to resolve an account balance when applicable.
• Identifies trends with payer rejections or denials and escalates these trends to leads/supervisors.
• Uses computer systems/technology to locate claims information to resolve account balances.
• Maintains compliance with patient financial services policies and procedures.
• Uses fax machine and other office equipment during normal daily operations.
• Reviews accounts based on patient or departmental inquiries and follows up with other Mercyhealth departments to resolve outstanding questions or claims at risk of non‑payment.
• Interacts with other Patient Financial staff members to provide pertinent information, share training documents, and seek guidance to resolve knowledge base deficiencies.
• Researches accounts denied for No Authorization as a priority to appeal or elevate to Precertification if a retro authorization may be needed.
• Performs billing functions when needed.
• Escalates high‑value accounts for a second‑level appeal if necessary.
• Reports equipment malfunctions and supply needs as necessary.
• Accesses available resources such as the patient accounting system, biller files, other Revenue Cycle areas, or payer databases to locate missing or incorrect information, applying creative problem‑solving to resolve errors for claim adjudication.
• Coordinates with management and external departments to resolve unresolved accounts and potentially create process redesign initiatives for long‑term root cause resolution.
• Completes special projects as assigned.
• Maintains a comprehensive awareness of all insurance company updates, including Federal and State guidelines.
• Meets productivity goals as assigned by the Revenue Cycle Director.

• High school diploma or equivalent.
• Microsoft Excel required, healthcare billing experience preferred.
• Undertakes self‑development activities.
• Basic understanding of working in multiple software applications simultaneously.

• Comprehensive Benefits Package: retirement plan with competitive matching contribution, medical, dental, and vision insurance options, life and disability…