Mercyhealth Wisconsin and Illinois ยท 1 day ago
Insurance Billing Representative, Patient Accounts
Rockford, IL
Full-time
Hybrid
New Grad, Entry LevelMercyhealth is a healthcare provider operating in Wisconsin and Illinois, seeking an Insurance Billing Representative for Patient Accounts. The role involves resolving claims with third-party payers, ensuring timely payments, and maintaining compliance with financial policies and procedures.
Health CareNon Profit
Responsibilities
Verifies claims are received by the payer and follows up to obtain payment via phone calls, portal or website use
Reviews claim adjustment reason codes or explanations of benefits received by the payer to determine what reasons for denials records are indicating for appropriate follow-up
After denial review, evaluates next steps and takes action to call payer, follows up with a resubmission or dispute/appeal/reconsideration as required by payer, or works internally to receive payment on account
Drafts an appeal or complete reconsideration forms when applicable based on payer requirements in a format that is logical and relates to the open denial of payment
Obtains and sends medical records during the appeals process when needed to substantiate medical necessity
Ability to review billing forms for both paper submissions and electronic submissions for accuracy
Calls patients or payers directly without hesitation to obtain needed information to resolve an account balance when applicable
Identify trends with payor rejections or denials and escalates these trends to leads/supervisors
Uses computer systems/technology to locate claims information to resolve account balances
Maintains compliance with patient financial services policies and procedures
Uses fax machine and other office equipment during the course of normal daily operations
Reviews accounts based on patient or departmental inquiries. Also, works and follows up with other Mercyhealth departments in a timely fashion if outstanding questions are not resolved and a claim is in jeopardy of not being paid
Interacts with other Patient Financial staff members to provide pertinent information, which may include training and document sharing , and to ask for guidance to resolve knowledge base deficiencies
Researches accounts at a higher level that are denied for No Authorization as a priority in the attempt to appeal or escalate to Precertification department if a retro authorization may be needed
Works billing functions when needed
Escalates high dollar accounts for a second level appeal if needed
Reports equipment malfunctions and supply needs, as necessary
Accesses available resources, such as the patient accounting system, biller files, other areas in the Revenue Cycle, or payer databases, to locate missing or incorrect information. Apply creative problem-solving skills in order to overcome obstacles and resolve errors for claim adjudication
Coordinates with management and external departments to resolve unresolved accounts and potentially create process redesign initiatives for long term root cause resolution
Completes special projects as assigned
Maintains a comprehensive awareness of all insurance company updates including Federal and State guidelines
Meets productivity goals as assigned by the Revenue Cycle Director
Qualification
Required
High school diploma or equivalent
Microsoft Excel Required
Healthcare Billing Experience Preferred
Basic understanding of working in multiple software applications at the same time
Benefits
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.
Company
Mercyhealth Wisconsin and Illinois
At Mercyhealth, our doctors, nurses and staff are committed to making lives better for our patients and their families.
Founded in 1889
5001-10000 employees
H1B Sponsorship
Mercyhealth Wisconsin and Illinois has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (2)
2024 (5)
2023 (6)
2020 (1)
Funding
Current Stage
Late StageLeadership Team
Nathan Schultz
Chief Technology Officer
Shawn David
Chief Technology Officer / Chief Security Officer IMS Technical Director
Company data provided by crunchbase