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Role Description

• 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.

Qualifications

• 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.

Requirements

• Knowledge of healthcare reimbursement programs, coding, and billing preferred.

Benefits

• 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

Company Description

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.

• #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