Patient Accounts Specialist

Mercy Health - Janesville, WI

Full-time - Entry Level

Janesville, WI

Ambulatory Health Care Services

About the position

The Patient Accounts Specialist at Mercyhealth is responsible for ensuring timely electronic submission of claims to third-party payers and following up on unpaid claims within 45 days. This role requires a strong understanding of billing procedures, federal and state regulations, and CPT coding, as well as effective communication and organizational skills to manage claims efficiently.

Responsibilities

• Process claims daily with in-depth knowledge of billing procedures by payer.
• Ensure no claims are older than 5 days in the CA queue.
• Research and correct claims in the McKesson system as needed.
• Maintain knowledge of federal and state regulations for Medicare and Medicaid claims.
• Understand CPT coding and modifiers for payment determinations.
• Establish contacts with payers to resolve contract issues.
• Collect and enter additional patient account information promptly.
• Update the Plus and/or Star system to reflect current account status.
• Work on mail/correspondence weekly to ensure currency.
• Communicate backlogs to supervisor or lead before week ends.
• Maintain organized files for easy document retrieval.
• Follow up on all accounts/claims daily/weekly to ensure timely processing.
• Prioritize work to prevent backlogs and assist team members as needed.

Requirements

• High school diploma or GED; or 1-3 months related experience/training; or equivalent combination of education and experience.
• Completion of Advanced Patient Billing Class or Certification in Patient Accounting (AAHAM-CPAT) preferred.
• Internal candidates must have a performance appraisal score of 400 for the previous two years.
• Knowledge of accounting software, spreadsheet software, and word processing software.

Nice-to-haves

• Experience in healthcare billing and coding.
• Familiarity with managed care reimbursement methodologies.
• Strong communication skills for effective interaction with payers and team members.

Benefits

• Comprehensive medical, dental, and vision insurance options.
• Retirement plan with competitive matching contributions.
• Life and disability coverage.
• Access to flexible spending plans.
• Generous paid time off plan that increases with tenure.
• Educational assistance programs for career advancement.
• Employee assistance programs and wellbeing resources.