Senior Specialist Accounts Receivable

Ensemble Health Partners•Charleston, SC

22h

About The Position

Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. The Senior Accounts Receivable Specialist is responsible for all follow-up and denial activities, including direct communication with commercial, governmental, and other payers to resolve claim payment issues and secure timely reimbursement. This role involves identifying trends in denied payments, understanding changes in insurance company policies for compliant billing, communicating with other departments to resolve denial issues, and submitting technical and clinical appeals. The Senior Specialist will also mentor AR Specialist team members, follow up on clean claim delays, and assist leadership with special projects for AR reduction and cash acceleration. Ensemble's purpose is centered on Customer Obsession, Embracing New Ideas, and Striving for Excellence, aiming to provide exceptional experiences and continuously innovate.

Requirements

Must demonstrate basic computer knowledge and 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.

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.
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.

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.