Mercy Health

  • Specialty Account Coordinator

    Requisition ID
    Position Type
    Full Time
    Gastroenterology Whiteside
  • Overview

    Job Template Header


    We’re a Little Different


    Our mission is clear. We bring to life a healing ministry through our compassionate care and exceptional service.  


    We don’t believe in jobs at Mercy, we believe in careers that match the unique gifts of unique individuals; careers that not only make the most of your skills and talents, but also your heart.


    At Mercy, you’ll feel our supportive community every step of your day, especially the tough ones. We’re a team and love working that way. That team is expanding, and we currently have exceptional opportunities to help our communities grow.

    Responsibilities and Qualifications

    The Specialty Account Coordinator is responsible multiple facets of patient account coordination including insurance/benefit verification, denials management, and collections. The Specialty Account Coordinator is also responsible for knowing what assistance programs, such as drug copay cards, that patients may qualify for, assisting patients in enrolling in those programs, monitoring services rendered, and billing the assistance programs for the applicable funds. This position requires a thorough understanding of claims programs for the applicable funds. This position requires a thorough understanding of claims procedures and insurance company regulations, as well as ophthalmology coding and billing. It requires monitoring of insurance company regulations for changes in pre-certification, documentation, or claims submission requirements. It also requires accuracy, attention to detail and the ability to communicate well with physicians, staff, patients, and insurance companies. The Specialty Account Coordinator also serves as a resource for other staff and patients, and always performs duties in a manner consistent with Mercy Service Standards. Performs duties and responsibilities in a manner consistent with our mission, values, and Mercy Service Standards.


    Productivity (20%)

    • Processes patient accounts in an assigned section (s) utilizing efficient methods and achieving optimum performance in accuracy and volume account management. Monitors assigned section (s} work flow, conduct quality audits and assists in the development of co-workers. Advises supervisor of internal progress and problems and of external problems with may hinder the completion of work within the section. Recommends solutions to problems. Assists with development of objectives and performance standards for sections{s) assigned. Implements aspects of new programs or services. Leads groups or task forces to accomplish special assignments. Reviews and suggests improvements in procedures and/or training guides.
    • Assesses, obtains, verifies, and documents patients insurance eligibility, benefits, and pre-certification requirements prior to services. This includes pre-certification for infused medications.
    • Assists the patients in completing financial assistance applications.
    • Assists the patients in enrolling for any applicable patient assistance programs (PAPs). Collects all applicable patient signatures and financial documents as well as physician documents and submits applications on patients behalf. Tracks application process to ensure all documents were received and reviewed in a timely manner by assistance program. Registers patients on-line for copay card programs per program guidelines.
    • Works with drug manufacturers to get drug replacement in certain circumstances. Registers patients for programs which allow patients who meet criteria for drug replacement prior to initialing treatment as a fall-back in case of denial. Works with pharmaceutical companies to appeal insurance carriers per their guidelines prior to drug replacement completion.
    • Manages denials by researching root causes, collaborating with leadership regarding process improvements to prevent additional denials, including but not limited to staff training and development, work-flow enhancements, and identifying system errors.
    • Processes ophthalmology patient accounts utilizing efficient methods and achieving optimum performance in accuracy.
    • Implements aspects of new programs or services.
    • Handles the most difficult patient complaints/program accounts. Models collaborative behavior with other staff members to accomplish work and departmental projects. Models positive and professional communication skills. Provides information and assistance to others regarding ophthalmology billing and/or business office procedures and readily shares experience and expertise with others.
    • Coordinates and updates patient assistance program guidelines.


    Quality (20%)

    • Maintains a superior quality standard and acts as an expert resource to other coworkers. Ability to audit the work of others, ind patterns requiring improvements and suggest action plans for remediation.
    • Reviews all treatment requests against NCCN/LCD guidelines or other peer reviewed compendiums.
    • Tracks patients who are enrolled in PAPs. Submits claims and supporting documentation as required by the specific PAPs. Collects payment from PAPs as appropriate, such as through prepaid credit cards provided by drug manufacturers
    • Maintains a superior quality standard. Is able to effectively audit the work of others, find patterns requiring improvement, and suggest action plans for remediation.


    System Proficiency (20%)

    • Uses and demonstrates an expert level of understanding of the patient accounting computer system, including system reports and security procedures. Serves as a resource for technical knowledge and sills of computer system. Utilizes resources to a respond to and resolve problem accounts within the designated time-frame. Maintains current Epic proficiency level for applicable role (EUPA=End User Proficiency Assessments).
    • Demonstrates exert proficiency in patient accounting procedures, such as researching and interpreting denials, reviewing account history, auditing account notes, etc.


    Communication (20%)

    • Handles the most difficult patient complaints/problem accounts. Models collaborative behavior with other staff members to accomplish work and departmental projects. Models positive and professional communication skills. Provides information and assistance to peers regarding billing/business office procedures. Provides guidance and support as needed to co-workers. Demonstrates effective verbal and written communication skills.
    • Advises supervisor or manager of issues which may hinder proper account management.
    • Demonstrates effective verbal and written communication skills.


    Knowledge (20%)

    • Maintains expert level of working knowledge of the department and is a resource to others to resolve problems or backlogs. Works with staff members in an advisory role to disseminate information about policies nd procedures and share expertise/experience with others. Trains employees
    • in the use of the financial computer systems, Department and Health System policies and practices. Demonstrates expert proficiency in Patient Accounting procedures, such as determining contractual allowances, interpreting denials, entering transactions, and interpreting others' transactions.
    • Stays abreast of contract, regulation, procedure, and other changes affecting the department. Serves as a subject matter expert and demonstrates a thorough understanding of third party requirements and regulations that affect job performance, including a strong understanding of HIPAA law.



    Because you’re committed to excellence, you understand the importance of being properly prepared for your role at Mercy. That’s why you’ll bring to your role the right set of qualifications:


    Education: Some college hours in Business, Finance and/or Accounting related courses preferred.


    Experience: A minimum of 3 years related experience required.


    Other skills & knowledge:  (skills, knowledge, abilities): Interperonal, organizational, and analytical skills required. Must posess ability to work in stressful situatons, meet deadlines, and perform daily responsibilities with consistent accuracy. Ability to use logic, good judgment ad be able to reapidly identify and initaiate corrective actions when problems arise. Must be able to communicate effectively providing good written and oral direction to co-workers. Must be able to deal effectively with VBO management and co-workers in demanding situations.


    We’ll Support You at Work and Home


    Our foundations are built on dignity and respect. Modern Healthcare Magazine named us as a “top 100 places to work.” We go out of our way to help people feel welcomed. We offer day-one comprehensive health, vision and dental coverage, PTO, and employer-matched retirement funds, even to part-time employees. We’re proud to provide tuition reimbursement to help you grow and learn new skills.


    What Makes a Good Match for Mercy


    Compassion and professionalism go hand-in-hand with us, along with exceptional quality care. Having a positive outlook and a strong sense of advocacy is in perfect step with our mission and vision. We’re also collaborative and are not afraid to do a little extra to deliver excellent care – that’s just part of our commitment. If that sounds like a fit for you as well, we encourage you to apply.


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