Responsibilities
- Mentors AR Specialist team members to help develop and improve their skills in the denials and appeals process.
- Examines denied and other non-paid claims to determine reason for discrepancies.
- Demonstrates initiative in resolving complex claims and proactively makes recommendations to management on specific trends or necessary interventions.
- Communicates directly with payers to follow up on outstanding claims, files technical and clinical appeals, resolves payment variances, and ensures timely and accurate reimbursement.
- Provides guidance to other team members on resolving complex claims and filing appeals.
- Ability to identify with specific reason underpayments, denials, and cause of payment delay.
- Works with management to identify, trend, and address root causes of issues in the A/R.
- Takes meeting minutes for payor escalation calls and provides feedback to the AR associates key takeaways from the calls.
- Maintains a thorough understanding of federal and state regulations, as well as payer specific requirements and takes appropriate action accordingly.
- Documents all activity accurately including contact names, addresses, phone numbers, and other pertinent information in the client’s host system and/or appropriate tracking system.
- Demonstrates initiative and resourcefulness by making recommendations and communicating trends and issues to management.
- Reviews escalations from other areas to AR as well as accounts that require escalation to other areas of Revenue Cycle.
- Assists the supervisor with DIBS calls as needed.
- Needs to be a strong problem solver and critical thinker to resolve accounts.
- Must meet productivity and quality standards as established by Ensemble.
- Performs other duties as assigned, including projects.
Requirements
- basic computer knowledge
- proficiency in Microsoft Excel
- 2 or 4-year college degree
- 1 or more years of relevant experience in medical collections, physician/hospital operations, AR Follow-up, denials & appeals, compliance, provider relations or professional billing
- knowledge of claims review and analysis
- working knowledge of revenue cycle
- CRCR, either upon hire or within 9 months of hire
- experience working the DDE Medicare system and using payer websites to investigate claim statuses
- working knowledge of medical terminology and/or insurance claim terminology
Nice to Have
- meet 120% Productivity and 98% Quality Assurance in each of the previous 3 months
- meet quality and productivity standards by day 90
- excel verbal skills
- problem solving skills
- critical thinking skills
- adaptability to changing procedures and growing environment
- meet quality and productivity standards within timelines set forth in policies
- meet required attendance policies
Benefits
- Bonus Incentives
- Paid Certifications
- Tuition Reimbursement
- Comprehensive Benefits
- Career Advancement
Additional Information
- This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Associates may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.
- Ensemble Health Partners is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws. Ensemble Health Partners also prohibits harassment of applicants or employees based on any of these protected categories. Ensemble Health Partners provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require accommodation in the application process, please contact TA@ensemblehp.com.
