PFS Customer Service Rep 1

Overview:

• Customer Service, Janesville, Days, Full Time
• Schedule: 8am-4:30pm Mon-Fri

Responds to all patient inquiries by performing an assessment of both hospital and professional accounts and initiates appropriate action to ensure customer satisfaction. Performs other duties as assigned.

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.

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

Subject matter expert in an area of responsibility

Certification and Licensure

Certification in Patient Accounts and/or Advance Billing Class Certificate

Special Physical Demands

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.

Level of Supervision

N/A

Supervises

N/A

Benefits:

Mercyhealth 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.