Financial Resource Specialist 1

Overview

The Financial Resource Specialist position requires extensive knowledge of Mercyhealth financial guidelines, collection policies, and government regulations related to billing and collections. The Financial Resource Specialist will be the embodiment of the hospital's mission, vision and values and will liaison with the various clinic and hospital locations to ensure financial policies are being adhered to. The Financial Resource Specialist will greet patients or family members in the various clinic and hospital settings and assist them in answering any questions or concerns they may have regarding their insurance coverage, financial assistance, billing, or payment options. The Financial Resource Specialist will have knowledge of all aspects of the revenue department from the registration process through the collection, billing, coding, and denial process. Financial Resource Specialists have an extensive knowledge base of all community, state, or federal government programs to provide assistance to patients who have no or limited ability to pay for their health care. They are expected to have a comprehensive knowledge base of alternative financial resources to counsel and educate patients on all available financial resource options. They will assist patients and family members with the Presumptive Eligibility process and follow up with patients to ensure they have secured a financial resource in place to pay for their health care. The Financial Resource Specialist also prepares complex estimates for services and counsels patients on their expected personal financial responsibility. They will keep up to date with insurance plans and payers so that they can appropriately counsel patients on their health care financial responsibilities. The Financial Resource Specialist will also work with patients and their insurance companies to resolve complicated billing and denial issues.

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 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 resolve 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 will 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.

EDUCATION AND EXPERIENCE

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

Mercyhealth offers a generous total rewards package to eligible employees including, but not limited to:

* Comprehensive Benefits Package: Mercyhealth offers a retirement plan with competitive matching contribution, comprehensive medical, dental, and vision insurance options, life and disability coverage, access to flexible spending plans, and a variety of other discounted voluntary benefit options.

* Competitive Compensation: Mercyhealth offers market competitive rates of pay and participates in various shift differential and special pay incentive programs.

* Paid Time Off: Mercyhealth offers a generous paid time off plan, which increases with milestone anniversaries, to allow employees the opportunity for a great work-life balance.

* Career Advancement: Mercyhealth offers a number of educational assistance programs and career ladders to support employees in their educational journey and advancement within Mercyhealth.

* Employee Wellbeing: Mercyhealth has a focus on wellbeing for employees across the organization and offers a number of tools and resources, such as an employer-sponsored health risk assessment and a Wellbeing mobile application, to assist employees on their wellbeing journey.

* Additional Benefits: Mercyhealth employees have access to our internal and external employee assistance programs, employee-only discount packages, paid parental and caregiver leaves, on-demand pay, special payment programs for patient services, and financial education to help with retirement planning.