WI3636937

1

High School Diploma/GED

High School Diploma/GED Equivalent

Unspecified

40

JOB REQUIREMENTS: Overview Insurance Billing Rep, Patient Accounts
Follow Up, Days, 80 Hrs / wks Location: MercyCare Bldg; Janesville, WI
Hybrid and flexible work schedule opportunities avaliable. Responsible
for ensuring claims are resolved with third party payers in a reasonable
time frame as defined by Revenue Cycle metrics. This includes working
claims that fail payer rejection edits in order to resolve errors and
submit corrected claims. Assesses errors and quickly and effectively
locates information to correct them and follow-up on claims for
resolution. Works with other areas in the Revenue Cycle to obtain
information necessary to correct errors or supply additional information
as necessary for claim adjudication. Remains up-to-date on regulatory
requirements through informal and formal updates, including self-study
of payer bulletins and guidelines. Performs other duties as assigned.
Responsibilities Verifies claims are received by the payer and follows
up to obtain payment via phone calls, portal or website use. Reviews
claim adjustment reason codes or explanations of benefits received by
the payer to determine what reasons for denials records are indicating
for appropriate follow-up. After denial review, evaluates next steps and
takes action to call payer, follows up with a resubmission or
dispute/appeal/reconsideration as required by payer, or works internally
to receive payment on account. Drafts an appeal or complete
reconsideration forms when applicable based on payer requirements in a
format that is logical and relates to the open denial of payment.
Obtains and sends medical records during the appeals process when needed
to substantiate medical necessity. Ability to review billing forms for
both paper submissions and electronic submissions for accuracy. Calls
patients or payers directly without hesitation to obtain needed
information to resolve an account balance when applicable. Identify
trends with payor rejections or denials and escalates these trends to
leads/supervisors. Uses computer systems/technology to locate claims
information to resolve account balances. Maintains compliance with
patient financial services policies and procedures. Uses fax machine and
other office equipment during the course of normal daily operations.
Reviews accounts based on patient or departmental inquiries. Also, works
and follows up with other Mercyhealth departments in a timely fashion if
outstanding questions are not resolved and a claim is in jeopardy of not
being paid. Interacts with other PFS staff members to provide pertinent
information and to ask for guidance to resolve knowledge base
deficiencies. Researches accounts at a higher level that are denied for
No Authorization as a priority in the attempt to appeal or escalate to
Precertification department if a retro\... For full info follow
application link. EOE&AA/M/F/Vet/Disabled. Mercy is an equal employment
opportunity employer functioning under Affirmative Action Plans.
\*\*\*\*\* APPLICATION INSTRUCTIONS: Apply Online:
ipc.us/t/852523C96E584D49