Patient Account Rep II - Physician Billing Office Details

Patient Account Rep II - Physician Billing Office

MERCY CLINICS INC. - Des Moines, IA

Employment Type : Full-Time

Overview: MercyOne Central Iowa operates four not-for-profit, Catholic medical centers in Des Moines, West Des Moines, Newton and Centerville and two specialty hospitals – MercyOne Children’s Hospital in Des Moines and MercyOne Rehabilitation Hospital in Clive (965 beds total) – along with more than 20 additional facilities that house more than 50 primary care, pediatric, internal medicine and specialty clinics. Founded by the Sisters of Mercy in 1893, MercyOne Central Iowa has the longest continually operating hospital in Des Moines and is also one of the largest employers in the state, with more than 7,000 employees and a medical staff of more than 1,000 physicians and allied health associates. MercyOne Central Iowa is a member of MercyOne, which was founded in 1998 through a collaboration between CommonSpirit Health and Trinity Health – two of the country’s foremost, not-for-profit Catholic health organizations. MercyOne has more than 20,000 colleagues in Iowa and surrounding states.Responsibilities: Responsible for the research, posting, and reconciling of payments, contractual adjustments, and denials. Ability to interpret different explanation of benefits and remittance advices from multiple payer. Contacting payers to resolve any discrepancies. Adhere to all cash posting processes, productivity expectations, and quality assurance standards.

• Demonstrates written, verbal, and nonverbal communication that is consistent with the Mercy Mission, Values and I Will Statements to all patients, families, visitors, medical staff, colleagues, vendors and other internal and external customers.
• Promotes the Spirit of Mercy by displaying an attitude and behaviors that are consistent with the Mercy Mission, Value and I Will Statements.
• Acknowledges patient rights with regard to confidentiality by maintaining patient confidentiality and following HIPAA guidelines and regulations at all times.
• Acts as a patient advocate by responding to and addressing all patient concerns in a timely manner.
• Maintains current on all mandatory employment requirements including but not limited to Orientation Attendance (new hires), CHI Mandatory Education Courses, CHI additional Education Courses, Health Review, TB Testing and Annual Flu Shot.
• Must be a self- started and demonstrate the ability to work independently by making appropriate decisions according to the organizational and departmental guidelines that fall within the scope of the position.
• Demonstrates the ability to understand and effectively utilize a highly complex billing system(s).
• Maintains current knowledge of all Federal, State and compliance regulations related to billing and insurance as required based on the scope of the position.
• Demonstrates an understanding of HCFA 1500 claim forms, CPT, ICD.9 and HCPCS codes specific to insurance carrier requirements as required based on scope of the position.
• Maintains clear and concise documentation in claims and/or online notes as required based on the scope of the position.
• Participates effectively as a team member.
• Maintains competent job performance or better.
• Maintains an organized work area that enhances the organizational/departmental image.
• Reports any and all issues related to workflow backlog or identified process related concerns to Manager.

• Responsible for the posting of all assigned cash payments, adjustments, and/or remark codes to the appropriate claim, service date and/or account from all EOB’s and ERA’s.
• Possesses ability to comprehend complex insurance claims and explanations of benefits in various payer formats
• Adheres to all cash posting processes and protocols
• Contacts payers to resolve issues necessary in order to reconcile and apply payments
• Reconciles each batch to the check deposit amount
• Initiates the refund/recoup process for all credit balances
• Maintains ability to recognize claim denials on EOB’s/ERA’s and applies information appropriately to allow for additional follow up as necessary
• Brings all variances to resolution within established timeframes
• Maintains productivity standards defined by management.
• Ability to research errors that resulted in unposted claim payments.
• Coordinate activities for unidentified payments.
• Maintains working knowledge of multiple payer websites
• Maintains knowledge of all government and non-governmental industry regulation changes.
  

• High school diploma or GED required.
• One year experience in accounts receivable required, preferably in a healthcare related industry.
• One year 10 key experience preferred.
• One year experience in CPT, ICD-10, HICFA 1500 preferred.