Patient Financial Services Follow-Up Representative, Revenue Cycle

This is a fully remote position, open to applicants in United States.

📋 Description

• Confirms that claims are received by the payer and follows up through phone calls, portals, or websites to secure payment.

• Analyzes claim adjustment reason codes or explanations of benefits provided by the payer to identify reasons for denials, facilitating appropriate follow-up.

• After reviewing denials, assesses subsequent steps and takes action by contacting the payer, following up with a resubmission or initiating a dispute/appeal/reconsideration as required by the payer.

• Prepares an appeal or completes reconsideration forms when necessary, adhering to payer requirements in a coherent format that addresses the open denial of payment.

• Acquires and transmits medical records during the appeals process when necessary to validate medical necessity.

• Proactively contacts patients or payers to gather essential information needed to resolve account balances when appropriate.

• Identifies patterns in payer rejections or denials and escalates these trends to leads/supervisors.

• Utilizes computer systems and technology to find claims information for resolving account balances.

• Adheres to patient financial services policies and procedures to ensure compliance.

• Reviews accounts in response to inquiries from patients or departments.

• Collaborates and follows up with other Mercyhealth departments promptly if there are outstanding questions that may jeopardize claim payment.

• Engages with fellow Patient Financial staff members to share relevant information.

• Investigates accounts that are denied for No Authorization as a priority, aiming to appeal or escalate to the Precertification department if retro authorization is necessary.

• Completes special projects as assigned.

• Keeps informed about all updates from insurance companies, including Federal and State guidelines.

• Achieves productivity targets set by the Revenue Cycle Director.

⛳️ Requirements

• High school diploma or equivalent.

• Proficiency in Microsoft Excel is required.

• Preferred experience in healthcare billing.

• Basic understanding of using multiple software applications simultaneously.

🏝️ Benefits

• Medical.

• Dental.

• Vision.

• Life & Disability Insurance.

• FSA/HSA Options.

• Generous, accruing paid time off.

• Paid Parental and caregiver leave.

• Career advancement and educational opportunities.

• Tuition and certification reimbursement.

• Certification Reimbursement.

• Well-being Programs.

• Employee Discounts.

• On-Demand Pay.

• Financial Education.

• Annual recognition/awards events.

• Partner appreciation days.

• Family entertainment/attractions discount.

• Community service/improvement opportunities.