PFS Customer Service Rep 1
- Janesville, WI
- Permanent
- Full-time
ResponsibilitiesEssential Duties and Responsibilities
- Researches and performs audits on patient accounts (including complex accounts) to determine where balances are due, from third party payers or patient responsibility.
- In-depth understanding of collection laws. Understands statement cycles, the bad debt process and how to balance files after the transfer process is complete.
- Has in depth knowledge of community based, state or federal government programs to provide assistance to patients who have no ability to pay for their health care needs. Screens patients and provides assistance with completion of the application process.
- 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 record, Chartview, MPI, etc.
- Familiar with managed care contract reimbursement rates. Understands terminology associated with contracts as well as familiar with the terminology and calculations used on a payment voucher and patient's explanation of benefits. Understands Medicare reimbursement of DRGs, APCs or physician fee schedules.
- Responds to patient inquiries via in person, mail, phone and/or email. Sends stat requests to appropriate partner and works with partner as needed to resolve patient issue/question.
- Responds to third party and patient requests on credit balances and initiates the refund process in the event monies are due back to the payer or patient.
- Documents all patient encounters on appropriate patient account/claim utilizing notes. Ensures account is updated to accurately reflect the current status.
- Serves as a liaison to all patient financial staff by maintaining good communication regarding any problems and/or resolutions to patient issues.
- Handles complaints and grievances, ACD monitoring and creates reports for follow-up on an ad hoc basis
- Subject matter expert with regards to assigned responsibilities.
- Provides training to new partners, as well as on an as-needed basis.
Subject matter expert in an area of responsibilityCertification and LicensureCertification in Patient Accounts and/or Advance Billing Class CertificateSpecial Physical DemandsThe Special Physical Demands are considered Essential Job Functions of the position with or without reasonable accommodations.
While performing the duties of this job, the employee is regularly required to use hands to finger, handle, or feel; reach with hands and arms and talk or hear. The employee is frequently required to sit. The employee is occasionally required to stand; walk; climb; or balance and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
BenefitsMercyhealth offers a generous total rewards package to eligible employees including, but not limited to:· Comprehensive Benefits Package: Mercyhealth offers a retirement plan with competitive matching contribution, comprehensive medical, dental, and vision insurance options, life and disability coverage, access to flexible spending plans, and a variety of other discounted voluntary benefit options.· Competitive Compensation: Mercyhealth offers market competitive rates of pay and participates in various shift differential and special pay incentive programs.· Paid Time Off: Mercyhealth offers a generous paid time off plan, which increases with milestone anniversaries, to allow employees the opportunity for a great work-life balance.· Career Advancement: Mercyhealth offers a number of educational assistance programs and career ladders to support employees in their educational journey and advancement within Mercyhealth.· Employee Wellbeing: Mercyhealth has a focus on wellbeing for employees across the organization and offers a number of tools and resources, such as an employer-sponsored health risk assessment and a Wellbeing mobile application, to assist employees on their wellbeing journey.· Additional Benefits: Mercyhealth employees have access to our internal and external employee assistance programs, employee-only discount packages, paid parental and caregiver leaves, on-demand pay, special payment programs for patient services, and financial education to help with retirement planning.