Sr Specialist, Transfer Diagnosis Related Group

Ensemble Health Partners•Charlotte, NC

About The Position

Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions and a comprehensive suite of point solutions to clients across the country, aiming to keep communities and hospitals healthy. Ensemble emphasizes the human touch in healthcare, empowering its people to challenge the status quo. The company's purpose is built on Customer Obsession, Embracing New Ideas, and Striving for Excellence, consistently delivering exceptional experiences and outstanding results. This career opportunity offers bonus incentives, paid certifications, tuition reimbursement, comprehensive benefits, and career advancement.

Requirements

1 - 2 years of job experience
Minimum of 1 -2 years of experience working with hospital insurance claims and a working knowledge of the hospital revenue cycle.
Associate degree or equivalent work experience required.

Nice To Haves

Bachelor’s degree preferred.
Basic knowledge of Medicare and managed Medicare concepts, including plan reimbursement.
Basic skills in Microsoft Office, including Excel, Word, and Teams.
Strong, clear, and effective communication, organization, and prioritization skills.
Effective and proven analytical skills that provide the foundation to identify potential underpayments.

Responsibilities

Work from inventory reports assigned by leadership to identify potential transfer DRG underpayment opportunities.
Using the validation process, ensure identified underpayments are pursuable utilizing resources including online Medicare administrative contractor (MAC) portals, DDE, CMS inpatient prices, Ensemble proprietary software, and client host systems.
Understand the Medicare PACT policy, the affected discharge dispositions, and post-acute service providers.
Identify and determine facility information for follow up and calls to MACs and post-acute care providers, including home health agencies, skilled nursing facilities, assisting living facilities and long-term care facilities.
Review patient medical records to determine if post-acute care was received and contacting the post-acute providers to determine dates of service and level of care provided.
Develop and maintain strong working relations with the assigned client and team members.
Respond to organizational and client needs appropriately and timely.