Performs all duties related to Medicare, Medicaid and insurance coverage verification and negotiating of rates, claims, processing,
and collections by performing the following duties.
Essential Duties and Responsibilities
Include the following and other duties may be assigned:
1. Verify eligibility, obtain benefit quotes, authorizations for services, negotiates reimbursement as appropriate, notify patients of
coverage criteria and verify qualifications are met for reimbursement by individual payor guidelines.
2. Prepares daily cash deposits for posting, updates cash log, verify payment accuracy, post payments, and determine appropriate
contractual adjustments, deductibles and co-pays. Researches and processes refunds, returns and bad checks.
3. Confirm revenue generated accurately. Audit charges/claims for qualifications by the appropriate payor's guidelines. Submit
claims electronically or by paper according to payor's specifications and filing limits. Update all HCPC codes, modifiers, ICD10 codes
according to payor's requirements.
4. Review and process unpaid claims for assigned accounts. Work and track denials and all correspondence from assigned payors.
Prepare formal appeals according to payor's specifications. Monitor appropriate reimbursement based upon contractual agreements
and fee schedules. Obtain necessary documents from patient's medical records. Identify and adjust ineligible revenues,
contractuals and uncollectibles/bad debts. Responsible for the timeliness of payments and minimizing the risk of uncollectibles/bad
debts based upon industry standards.
5. Calls and/or mails correspondence, statements and invoices to customers as necessary in order to update accounts. Maintain
patient account notes with all correspondence, calls or any activity on the account. Receive calls and explain coverage criteria and
the calculations of the charges.
6. Performs month end close functions including financial, tracking and productivity reporting.
7. Complies with guidelines specific to accounts receivable policy and procedures, regulatory bodies, payor sources, individual
company's policy and procedures and other appropriate sources. Maintain knowledge on payor requirements and guidelines.
8. Maintains knowledge of products and services available through the department and other associated organizations.
9. Protects confidentiality of information. Follow guidelines for the release of medical information.
Education:
High School Diploma/ GED required
Computer skills, verbal communication skills and written communication skills. Preferred previous experience in medical, billing or related fields, medical terminology, ICD10 codes and HCPC codes.
As a Mercy Health associate, you're part of a Mission that matters. We support your well-being—personally and professionally. Our benefits are built to grow with you and meet your unique needs, every step of the way.
All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you'd like to view a copy of the affirmative action plan or policy statement for Mercy Health – Youngstown, Ohio or Bon Secours – Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employers, please email [email protected]. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at [email protected]
