Essential Duties and Responsibilities

• Interpret and understand coverage and benefit limitations by having a comprehensive understanding of benefits and state requirements for multiple markets.
• Identify trends and suggest and develop efficiencies in the revenue cycle through review and trending of payer contracts and reimbursement trends.
• Research and trends denials from payors.
• Reads through healthcare contracts and contract language and ensures proper contract workflows.
• Researches remittances and Explanation of Benefits (EOBs) for complete accurate payments or denials.
• Work with payers to understand specific reasons for variances and/or denials and measures to prevent future denials.
• Research payer policies and requirements and utilize knowledge to determine whether an appeal is required and to get claims overturned.
• Develop sound and well-supported appeal arguments, where an appeal is warranted.
• Submits corrected claims and appeals.
• Coordinates appeals with clinical or coding areas within the revenue cycle.
• Requests appropriate adjustments, when required.
• Provide training and guidance to team members on market specific issues by providing feedback to management on claims and provider issues, and updating client business rules.
• Partner with Reimbursements team to assist in completing all other tasks as necessary to ensure accurate and timely internal turnaround times.

Culture of Excellence Behavior Expectations

To perform the job successfully, an individual should demonstrate the following behavior expectations:

Quality - Follows policies and procedures; adapts to and manages changes in the environment; Demonstrates accuracy and thoroughness giving attention to details; Looks for ways to improve and promote quality; Applies feedback to improve performance; Manages time and prioritizes effectively to achieve organizational goals.

Service - Responds promptly to requests for service and assistance; Follows the Mercyhealth Critical Moments of service; Meets commitments; Abides by MH confidentiality and security agreement; Shows respect and sensitivity for cultural differences; and effectively communicates information to partners; Thinks system wide regarding processes and functions.

Partnering - Shows commitment to the Mission of Mercyhealth and Culture of Excellence through all words and actions; Exhibits objectivity and openness to other's views; Demonstrates a high level of participation and engagement in day-to-day work; Gives and welcomes feedback; Generates suggestions for improving work: Embraces teamwork, supports and encourages positive change while giving value to individuals.

Cost - Conserves organization resources; Understands fiscal responsibility; Works within approved budget; Develops and implements cost saving measures; contributes to profits and revenue.

Education and Experience

Associate's degree in finance, business, or healthcare administration and 3 years' experience working in revenue cycle, denials management and contract management required. 5 years of experience in lieu of degree.

Certification and Licensure

N/A

Skills and Abilities
Knowledge of healthcare reimbursement programs, coding, and billing preferred.
Special Physical Demands

The 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 frequently required to sit; use hands to handle, finger, feel; reach, talk and hear. The employee is occasionally required to stand and walk. This is light work exerting up to 25 pounds of force occasionally. Specific vision abilities required by this job include constant close vision. Frequent ability to adjust focus. Prolonged sitting. Manual dexterity needed to operate telephone and keyboard.

Level of Supervision

N/A

Supervises

N/A

PAY RANGE:

$21.00 - $31.50

Mercyhealth is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identify, national origin, disability, or protected veteran status.

Mercyhealth offers competitive pay and a comprehensive benefits package including:

• 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

Click here for more details regarding Mercyhealth Careers Benefit Information.

At Mercyhealth, we don’t simply hire people, we empower employee-partners who are passionate about making lives better. As an integrated health system, we deliver exceptional, coordinated across seven hospitals, 85 primary and specialty clinics, and a team of over 7,500 professionals serving northern Illinois and southern Wisconsin.

Mercyhealth has been nationally recognized for our commitment to our people and culture, including:

• #1 in the nation on AARP's Best Employers for Workers Over 50

• One of Working Mother magazine's 100 Best Companies for Working Mothers

• A Top 50 Company and Top 10 Nonprofit for Executive Women