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 healthcare environment.

• Follow and administer all Mercyhealth financial policies and guidelines.
• Maintain knowledge of collection laws, statement cycles, and the bad debt process.
• Understand the registration and cash drawer process and adhere to all cash compliance policies.
• Perform audits on patient accounts to determine balances due to third‑party payers or patient responsibility.
• Meet with patients in person or via telephone to counsel them on billing concerns, account balances, service costs, and insurance resources.
• Establish and follow up on payment plans with patients.
• Process refunds and pay‑in‑full discounts.
• Communicate with physicians, patient care staff, and hospital/clinic reception about out‑of‑network insurance status, medical urgency, and other billing/insurance issues.
• Verify charge accuracy using medical records, chart view, MPI, billing, and coding reviews.
• Navigate the billing system and review patient accounts for accuracy.
• Initiate follow‑up with patients, billing, coding, and insurance companies to secure payment.
• Understand managed care contract reimbursement rates, government and commercial insurance rates, and housing terms used on payment vouchers.
• Maintain extensive knowledge of government, marketplace, Care Credit, foundation grants, and other financial resource programs.
• Assist patients with copay and drug replacement assistance.
• Screen patients for charity care eligibility and complete the application process.
• Screen self‑pay patients for presumptive Medicaid eligibility and perform follow‑up to ensure coverage.
• Complete insurance eligibility, benefit verification, and pre‑certifications as required.
• Monitor patient work queues and resolve outstanding balance issues.
• Collect payment from self‑pay patients, set payment arrangements, or refer to financial resources.
• Respond to patient inquiries via in‑person, mail, phone, or email.
• Send status requests to appropriate departments to resolve patient issues.
• Process credit balances and initiate refunds when monies are due back to payer or patient.
• Act as liaison between patient, payors, and Mercyhealth partners.
• Meet Patient Access department guidelines for daily patient contact, collection goals, and benchmarks.
• Document all patient encounters accurately and update account status.
• Perform high‑level service recovery to resolve patient concerns and manage complaints and grievances until resolution.
• Research denied claims and reconcile information.
• Manage multiple tasks with efficiency, work independently, and maintain customer satisfaction.
• Provide training and mentoring to team members and participate in educational programs.

• High school graduate preferred.
• Two years of customer service and/or collections experience.
• Knowledge of reimbursement practices for commercial and government payers preferred.
• Medical terminology preferred.

• Excellent oral and written communication and organizational skills.
• Strong problem‑solving ability.
• Knowledge of health care systems and databases.
• Basic computer proficiency (Word, Excel, Outlook, etc.).
• Ability to multitask, prioritize, and handle challenging conversations professionally.

• Read, interpret, and communicate written documents such as emails, insurance documents, guidelines, instructions, and manuals.
• Write routine reports and correspondence.
• Communicate with customers and partners effectively.
• Spanish language ability desirable.

• Add, subtract, multiply, and divide using whole numbers, common fractions, and decimals.
• Compute rates, ratios, and percentages; interpret basic graphs.

• Apply common sense understanding to carry out written, oral, or diagram instructions.
• Deal with problems…