Mercy Health

Compensation

Full Description

The Accounts Receivable Specialist is responsible for implementation and coordination of fiscal transactions in a timely and accurate manner. This includes claims processing, cash collection, claims resolution, resolving credit balances, EOM balancing and monthly statements. Responsible for pre claim review to assure billing compliance as required by company. Is accountable for complying with all policies, procedures and regulations related to billing all Medicare, Medicaid and other Third Party Payors. Mission/Core Values: It is expected that all of the duties and responsibilities of this position will be performed in a manner consistent with the Ministry’s Standards of Behavior (CARE; Compassion: seeks to understand, listen and explain; Advocate: is the voice for the vulnerable; Respect: demonstrates the highest regard for and welcomes all people; Excellence: commits to the highest standard of quality care, joyful service, and teamwork) and in a manner that reflects the core values of Mercy Health which are: Excellence, Human Dignity, Justice, Compassion, Sacredness of Life and Service. All supervisors and above are expected to model the organizational mission and values through their daily actions, decision making and priority setting. All supervisors and above are expected to develop, implement and monitor short and long range plans to meet or surpass standards consistent with the overall strategic plan. 50%Examines denied and underpaid claims to determine reason for discrepancies. Communicates directly with payers to follow up on outstanding claims, file appeals, resolve payment variances, and ensure timely reimbursement. Ability to identify with specific reason underpayments, denials, and cause of payment delay. Works with management to identify, trend, and address root causes of issues in the A/R. Maintains a thorough understanding of federal and state regulations, as well as payer specific requirements and taken appropriate action accordingly. Documents activity accurately including contact names, addresses, phone numbers, and other pertinent information. Demonstrates initiative and resourcefulness by making recommendations and communicating trends and issues to management. Needs to be a strong problem solver and critical thinker to resolve accounts. 20%Responsibilities include posting remittance advice to patient accounts, resolving any errors after posting payments, posting guarantor payments, reconciling all posted cash, and requesting refunds. 11%Submit claims electronically or by paper according to payor specifications and filing limits. 10%Performs pre billing audits to assure billing compliance as required by company. 5%Answers all incoming phone calls to the business line accepting payments, answering billing questions, assisting patients with financial assistance and providing service recovery as needed. 2%Process patients statements monthly per policy. 2%Reviews all credit balances and processes as required by Medicare, Medicaid and all Third Party Payors. The above is intended to describe the general content and functions of this job. It is not to be construed as an exhaustive list of all duties or responsibilities. Employees may be required to perform other job related duties as required by their supervisor, subject to reasonable accommodation. The job description is subject to continual revisions as needed for patient care. Due to the services and care provided by this institution, personnel may be requested to serve in related capacities as determined by their qualifications in a different unit, department, and campus, in an effort to not disrupt patient care and continue to provide a safe environment to our patients. All employees are expected to follow Mercy Health policies and procedures, maintain high standards of safe work performance, and maintain good attendance and punctuality. MINIMUM QUALIFICATIONS Minimum Years and Type of Experience: High School Diploma. One year experience in medical collections or professional billing required. Other Knowledge, Skills and Abilities Required: Must demonstrate basic computer knowledge, ability to use standard office equipment and basic MS Office software. Problem solving skills related to account resolution. Adapt to changing procedures and growing environment. Other Knowledge, Skills and Abilities Preferred: 1-3 years of relevant experience in medical collections or professional billing preferred. Knowledge of claims review and analysis.