PFS Specialty Group Representative

MERCY HEALTH CORPORATION • Janesville, WI • 3h ago

JOB REQUIREMENTS: Overview Responsible for billing and resolving all
balances on Workers Compensation, Third Party Liability, Hospice,
Skilled Nursing Facilities, Occupational Health and other specialty
service accounts in the hospital and physician billing systems, in
addition to handling all inbound calls and making outbound calls related
to these areas. This representative will have knowledge of all aspects
of revenue cycle processes from the registration process through the
billing and collection process. Performs other duties as assigned.
Responsibilities Essential Duties and Responsibilities Research and
preform audits on patient accounts to determine balances are being
billed to the correct payer. Thorough understanding of how to identify
if charges on a patient\'s account are correct. In depth understanding
of what information is available to assist in the process, such as the
medical records, chart view, MPI, etc. In-depth understanding of
collection laws pertaining to worker compensation and third party
liability claims. Become fluent and knowledgeable in the Single Billing
Office environment within Epic Maintains a working knowledge of common
billing and account resolution practices and requirements for hospital
and/or clinic billing (SBO). Knowledge of how to work a claim from
beginning to end Learn and create in-depth knowledge of all applications
used by Patient Financial Services partners such as: Epic, Agility,
Connex, Kronos, OneSource, Microsoft Word, Microsoft Outlook, Claim
source, On-Base, etc. Identifies the correct filing order per department
processes when multiple insurances are involved Responds to inquiries
from patients, insurance companies, attorney offices and outside vendors
via mail, phone and/or email. Responds to inquiries regarding credit
balances on Workers Compensation, Third Party Liability, Hospice,
Skilled Nursing Facilities and Occupational Health accounts and
initiates the refund process in the event monies are due back to the
payer or patient. Responds to Billing reviews/ inquiries from other PFS
groups such as Billers, Follow-up, Cash posting and Customer Service.
Documents all encounters on appropriate patient account/claim utilizing
notes. Ensures account is updated to accurately reflect the current
status. Protects privacy and confidentiality of customers, patients and
partners in accordance with Mercyhealth policies, the Code of Ethics and
HIPAA laws. Review all Work Comp, TPL and personal injury settlement
requests before sending them to the Supervisor. Work special projects
and other job duties as assigned Verifies claims are received by the
payer and follows up to obtain payment via phone calls, portal or
websites. Reviews failed claims, resolves disputed and denied claims.
Obtains and sends medical records as needed for... 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/52FB13EECEFC43BF

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