Mercyhealth Wisconsin and Illinois

The role involves submitting electronic and manual medical claims while ensuring they are clean and compliant with regulatory requirements. It also requires resolving billing errors, analyzing coding, and coordinating with departments to resolve unbilled accounts.

The role involves verifying insurance claims, following up on unpaid accounts, and managing the appeals process for denied claims. It also requires identifying payer rejection trends and coordinating with internal departments to resolve account balances.

Reviews and interprets provider documentation to ensure accurate procedure and diagnosis code selection within the Epic system. Conducts audits, researches coding inquiries, and provides education to providers to improve documentation and coding accuracy.

The Director oversees the HIM and professional coding programs, ensuring accurate documentation and adherence to regulatory standards. They also manage coding and CDI teams, conduct trend analyses, and implement corrective actions to address claim denials and compliance issues.

The role involves supporting the configuration and maintenance of various Workday Core Financials modules, developing best practices for system use, and collaborating with cross-functional teams to implement enhancements based on business requirements. This position also requires managing Workday semi-annual releases, troubleshooting escalated issues, and developing internal training materials for end users.

The specialist is responsible for identifying scheduled patients needing pre-certification, gathering necessary patient data and clinical documentation, and contacting insurance companies to obtain authorizations and determine benefits. They must coordinate follow-up to ensure procedures are authorized before the service date while meeting all payor requirements for payment.