Mercyhealth Wisconsin and Illinois

Coordinates Medicare and governmental payment policies, compliance, and reporting for hospital and clinic entities. Manages annual cost report submissions and performs pro forma financial analyses for new or changed services.

Responsible for verifying claim receipt, following up on unpaid claims, and managing the appeals process for insurance denials. The role involves identifying payer trends and collaborating with internal departments to resolve account balances.

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.

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.