PFS Specialty Group Representative

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