Patient Access Specialist

Job Title

Essential Duties And Responsibilities

Research payer denials related to referral, pre-authorization, medical necessity, case management, non-covered services, and billing resulting in denials and delays in payment. Initiate appeals with insurers appropriately.

Submit detailed, customized appeals to payers based on review of medical records and in accordance with Medicare, Medicaid, and third-party guidelines as well as Mercyhealth Revenue Cycle policies and procedures.

Identify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up, and/or root cause resolution.

Initiates, obtains, and documents referrals/authorizations/pre-certifications in appropriate systems.

Ensures compliance with Access and Revenue Cycle related policies and procedures.

Completes accounts in assigned work queues.

Maintains a high level of professionalism and provides a quality patient experience.

Ensures compliance with reporting related to demographics and federal and state requirements.

Contacts insurance companies or employer groups via phone, web portals, electronic applications, or other appropriate means to determine eligibility and benefits for necessary services to obtain financial resolution and payment on account.

Maintains current knowledge of payor payment provisions and regulations to ensure correct data is gathered and documented.

Documents activity within appropriate EMR or patient accounting systems.

Demonstrates an understanding and follows patient confidentiality policies and all HIPAA Regulations.

Performs other clerical duties as needed such as faxing, filing and photocopying.

Subject matter expert with regards to assigned responsibilities.

Provides training to new partners, as well as on an as-needed basis.

Ensures compliance with Patient Access and Revenue Cycle related policies and procedures.

Reviews external orders/referrals to ensure authorization and compliance requirements are met.

Manages other duties as assigned.

Education And/Or Experience

High school diploma or equivalent preferred. Two years of customer service experience preferred. Two years of healthcare registration, scheduling, or physicians' office experience required.

Certification/Licensure

Healthcare revenue cycle related certification or an equivalently designated certification approved by management required within 1 year of hire.

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 care 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