Responsibilities

Overview

The Financial Resource Specialist position requires fundamental knowledge of Mercyhealth financial guidelines, collection policies, and regulations related to billing and collections. The Financial Resource Specialists 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 billing or payment options. The Financial Resource Specialist will have knowledge of all aspects of the department process from the registration process through the billing process. Patient Financial Counselors also assist patients and family members with the Presumptive Eligibility process and provide information related to various resources to obtain health care coverage. The Patient Financial Counselor also prepares and provides estimates of services to patients and completes benefit verification or precertification's as required.

Essential Functions

- Follow and administer all Mercyhealth financial policies and guidelines. - Meet with patients face to face or via telephone to counsel patients/customers on billing concerns, account balances, services costs/estimates and various insurance resources. - Communicate with physicians, patient care staff and hospital/clinic reception regarding out of network insurance status and other patient billing/ insurance issues. - Navigate the billing system and review patient accounts for accuracy. Initiates appropriate follow-up with patient, billing department, coding department, and insurance companies to ensure payment for services. - Maintain a knowledge base of programs offered through the government, the insurance marketplace, and the Mercy Community Care program. 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. - Establish payment plans with patients and follow up on broken payment arrangements - Educate patients and other Mercy partners on payment guidelines and resources. - Monitor patient Work queues and resolve outstanding balance issues. Contacts patients with self-pay balances to collect payment and/or set payment arrangements - Responsible for meeting Patient Access department guidelines for daily patient contact, collection goals, and department benchmarks. - Research denied claims through review of system/account/process to reconcile information. - Performs insurance verification and pre-certification activities for procedures when necessary. - Records and maintains thorough documentation of activities performed and patient conversations on the patients.

Minimum Qualifications

Graduate of high school or equivalent One year customer service and/or collections experience required Knowledge of reimbursement practices for commercial and government payers preferred Medical terminology preferred

Job Based Competencies

Excellent oral and written communication skills/organizational skills. Strong problem solving skills. Knowledge of various health care systems and databases desirable. Knowledge of general computer applications (word, excel, outlook, etc.) Language Skills Ability to read and interpret documents such as emails, insurance documents, guidelines, instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak and communicate effectively to customers and other partners. Ability to speak Spanish desirable. Mathematical Skills Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret basic graphs. Reasoning Ability Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.

Responsibility

Some independent judgment is required, but alternatives are limited by standard practices or procedures.

Physical Requirements

While performing the duties of this job, the employee is regularly required to walk; use hands to finger, handle, or feel; reach with hands and arms; climb or balance; stoop, kneel, crouch, or crawl; and talk or hear. The employee is frequently required to sit and work at a computer for long periods of time. The employee is occasionally required to stand. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus. While performing the duties of this job, the employee must have good manual dexterity to operate keyboard and telephone; repetitive finger/wrist movement associated with use of keyboard; prolonged sitting. The employee must be able to lift or move office related objects.

Public Contact

Partners, physicians, nurses, patients/family, visitors and insurance companies