PFS Specialty Group Representative

MERCY HEALTH CORPORATION • Janesville, WI • 2d ago

JOB REQUIREMENTS: OVERVIEW Experienced Patient Financial Services and
Revenue Cycle professional with expertise in account auditing, insurance
billing, denial resolution, and complex claims management. Proficient in
Epic SBO and healthcare revenue cycle systems, with a strong background
in Workers\' Compensation, Third-Party Liability, appeals, and
reimbursement processes. Skilled at collaborating across teams, ensuring
HIPAA compliance, and delivering accurate, timely account resolution
while consistently meeting productivity goals. SCHEDULE: Full -Time, 40
hours per week SHIFT: Hybrid, Flexible Schedule between 7:00am-6:00pm
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... 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/A6778E62D7F74DFE

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