Insurance Services Rep II (REMOTE)

📋 Description

• • Own the full life-cycle of insurance receivables for Mercy’s multi-state health system, driving the collection and resolution of unpaid, denied, and underpaid claims that total millions of dollars in annual revenue. You will be the critical link between patients, payers, and Mercy’s clinical teams, ensuring every dollar owed is accurately captured and promptly collected.
• • Triage and prioritize high-volume claim queues daily—often 150+ accounts—using Epic Resolute Hospital Billing and Ambulatory modules to identify root-cause denials, coding discrepancies, authorization gaps, and contract variances. Your analytical mindset will turn raw data into actionable work plans that reduce aged receivables and improve cash flow.
• • Serve as the payer expert for commercial, Medicare, Medicaid, and self-funded plans, interpreting remittance advice, EOBs, and 835/837 files to determine correct reimbursement. When claims are short-paid or denied, you will craft concise, evidence-based appeals supported by clinical documentation, medical policies, and contract language that consistently overturn denials and secure additional revenue.
• • Collaborate in real time with coders, charge-audit nurses, patient-access staff, and physician offices to correct demographic, insurance, and authorization errors before they reach the payer. Your proactive outreach reduces future denials and shortens the revenue cycle by days or even weeks.
• • Mentor Level I Insurance Services Representatives by sharing payer-specific tips, Epic shortcuts, and denial-resolution playbooks. Your intermediate expertise elevates team performance and creates a culture of continuous learning in a fully remote environment.
• • Generate and interpret daily, weekly, and monthly KPI dashboards—aged AR, denial rate, appeal success rate, and cash collected—presenting findings to Revenue Cycle leadership. Your insights directly influence process-improvement initiatives that have already saved Mercy over $3 million in the past fiscal year.
• • Uphold Mercy’s Mission, Values, and Service Standards in every interaction, treating patients, families, and colleagues with dignity and compassion. Whether you are on the phone with a confused patient or negotiating with a payer analyst, your empathy and professionalism reflect Mercy’s 195-year heritage of caring for communities.
• • Maintain strict compliance with HIPAA, payer regulations, and Mercy’s internal audit controls. You will document every action in Epic with clear, concise notes that withstand both internal QA reviews and external payer audits.
• • Continuously expand your knowledge of evolving payer rules, federal and state billing regulations, and Epic enhancements through Mercy’s tuition support and on-demand learning platform. Your growth fuels both personal career advancement and Mercy’s ability to adapt to an ever-changing healthcare landscape.
• • Work from the comfort of your home office anywhere within Mercy’s North Central region while staying seamlessly connected through Microsoft Teams, secure VPN, and dual-monitor setups provided by Mercy IT. You will enjoy flexible scheduling options that support work-life balance without compromising productivity or team collaboration.