[Remote] Senior Accounts Receivable Specialist

Note: The job is a remote job and is open to candidates in USA. Ensemble Health Partners is a leading provider of technology-enabled revenue cycle management solutions for health systems. The Senior Accounts Receivable Specialist is responsible for managing follow-up and denial activities, resolving claim payment issues, mentoring team members, and ensuring compliance with billing practices.

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, resolve 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

Skills

• CRCR, either upon hire or within 9 months of hire. (Or other approved job relevant certification, as approved by SVP of department.)
• 1 to 3 Years
• 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
• High School Diploma, GED, or Equivalent Experience
• 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. Failure to meet this standard will result in demotion to AR Specialist and will become eligible to re-apply for Sr AR Specialist 90 days following the demotion
• 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
• 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

Benefits

• Bonus Incentives
• Paid Certifications
• Tuition Reimbursement
• Comprehensive Benefits
• Career Advancement
• Associate Benefits – We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.
• Growth – We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.
• Recognition – We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.

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