Financial Resource Specialist

Overview

Help patients understand and manage their healthcare bills by reviewing accounts, explaining insurance coverage, setting up payment plans, and connecting patients with financial assistance resources. This role works closely with patients, insurance companies, and healthcare teams to resolve billing concerns, ensure accurate payments, and provide excellent customer service in a fast‑paced environment.

Schedule:

40 hours per week.

Location:

Javon Bea Hospital, Rockford, IL.

• 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 review 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…