Financial Resource Specialist

3 days ago

Lake Geneva, Wisconsin, United States Mercy Health Full time

Job Summary

This position is responsible for ensuring timely and accurate verification and authorization of patient care services to facilitate financial reimbursement. The successful candidate will possess excellent communication and organizational skills, with the ability to work effectively with multiple stakeholders, including insurance companies, physicians, and patients.

Key Responsibilities

  • Verify patient insurance benefits and coverage for specialty services, surgeries, and other medical procedures.
  • Contact insurance companies and employers to determine eligibility and benefits for necessary services.
  • Collaborate with clinical offices and primary care physicians to resolve issues related to incomplete or invalid referrals.
  • Follow up with insurance companies to ensure timely payment and resolution of claims.
  • Obtain required clinical documentation to support authorization and reimbursement processes.
  • Ensure accurate and timely documentation of referral authorizations and precertifications in relevant systems.
  • Resolve pre-certification, registration, and case-related concerns prior to patient appointments.
  • Coordinate follow-up to ensure all payor requirements are met and payment is expected.
  • Maintain current knowledge of payor payment provisions and regulations.
  • Assist with appeals and denials related to referrals and reimbursement.

Requirements

The ideal candidate will possess a high school diploma or equivalent, with one year of experience in healthcare registration, scheduling, or physicians' office experience. Completion of 24 hours of coursework in a business or healthcare-related field of study may be considered in lieu of experience. Knowledge of third-party payor requirements, basic medical terminology, and ICD-9, ICD-10, and CPT coding is preferred. Excellent customer service and telephone etiquette are essential.

Skills and Abilities

The successful candidate will possess excellent communication and organizational skills, with the ability to work effectively with multiple stakeholders. Proficiency in Microsoft Office Suite, including Outlook, Excel, and Word, is required. The ability to communicate clearly and concisely, both verbally and in writing, is essential. The candidate should be able to handle stress and problem-solve, with the ability to work independently and as part of a team.

Work Environment

The work environment is a fast-paced, dynamic setting with multiple stakeholders and deadlines. The successful candidate will be able to work effectively in this environment, with the ability to prioritize tasks and manage time efficiently.

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