Senior Accounts Receivable Specialist

Ensemble Health Partners•Work at Home - Oklahoma - Other, OK

15d•$19 - $21•Hybrid

About The Position

This position performs all follow-up and denial activities for Ensemble, a leading provider of technology-enabled revenue cycle management solutions for health systems. The role is responsible for following up directly with commercial, governmental, and other payers to resolve claim payment issues and secure appropriate and timely reimbursement. The Senior Specialist will identify trends in denied payments, remediate issues, stay informed about changes in insurance company policies, communicate with other departments to resolve denial issues, and submit technical and clinical appeals. Additionally, this role will mentor AR Specialist team members, assist leadership with special projects for AR reduction and Cash Acceleration, and maintain a thorough understanding of federal and state regulations and payer-specific requirements. The position requires strong problem-solving and critical thinking skills to resolve accounts and meet productivity and quality standards.

Requirements

1 to 3 Years of job experience.
Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences.
Must demonstrate basic computer knowledge.
Must demonstrate proficiency in Microsoft Excel.
Internal candidate must have met 120% Productivity and 98% Quality Assurance in each of the previous 3 months.
External candidates must meet quality and productivity standards by day 90.
Excellent Verbal skills.
Problem solving skills, the ability to look at account and determine a plan of action for collection.
Critical thinking skills, the ability to comprehend tools provided for securing payment, and apply them to differing accounts to result in payment.
Adaptability to changing procedures and growing environment.
Meet quality and productivity standards within timelines set forth in policies.
Meet required attendance policies.
Requires one certification per field (e.g., CRCR), either upon hire or within 9 months of hire. (Or other approved job relevant certification, as approved by SVP of department.)

Nice To Haves

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 preferred.
Knowledge of claims review and analysis.
Working knowledge of revenue cycle.
Experience working the DDE Medicare system and using payer websites to investigate claim statuses.
Working knowledge of medical terminology and/or insurance claim terminology.

Responsibilities

Performs all follow up and denial activities.
Follows up directly with commercial, governmental, and other payers to resolve claim payment issues, to secure appropriate and timely reimbursement and response.
Identifies trends in denied payments by insurance companies to remediate issues.
Identifies changes with insurance company policies to ensure compliant billing.
Communicates with other departments to resolve denial issues.
Submits technical and clinical appeals in a timely manner.
Mentors the AR Specialist team members to help develop and improve their skills in the follow up, denials and appeals process.
Follows up on clean claim delays from payors and adds issues to the escalation spreadsheets.
Assists leadership with special projects for AR reduction and Cash Acceleration.
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, resolve payment variances, and ensures timely and accurate reimbursement.
Provides guidance to other team members on resolving complex claims and filing appeals.
Identifies specific reasons for underpayments, denials, and causes of payment delays.
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.
Meets productivity and quality standards as established by Ensemble.
Performs other duties as assigned, including projects.