Accounts Receivable Escalation Specialist

careers-ventrahealth; United States; On-site; USD 45,000 - 60,000; Full time

Benefits offered by this job

Performance-based incentive plan

Discretionary bonus

Job summary

Ventra Health is seeking an Accounts Receivable Escalation Specialist to analyze collections, resolve non-payables, and handle bill inquiries for complex issues. You will follow up on denials and ensure payer reimbursement aligned with client contracts.

You will write appeals, review accounts, and collaborate with insurance companies to resolve outstanding claims while meeting production and quality standards; offshore engagement experience is a plus and a discretionary incentive bonus may apply.

Qualifications

• High School Diploma or GED required.
• 1+ year data entry and 1+ year medical billing/claims resolution preferred.
• AAHAM and/or HFMA certification preferred.
• Experience with offshore engagement and collaboration desired.

Responsibilities

• Follow up on claim rejections and denials to ensure reimbursement.
• Process AR work lists in a timely manner.
• Write appeals to resolve claim denials.
• Identify and resolve denied, non-paid, and/or non-adjudicated claims.
• Communicate with insurance companies about claim status.
• Meet production and quality standards.
• Perform special projects as assigned.

Skills

Medical billing rules

Communication skills

Time management

Office software

Education

High School Diploma or GED

AAHAM/HFMA certification

Tools

Microsoft Excel

Microsoft Outlook

Microsoft Word

Database software

Job description

About Us

Ventra is a leading business solutions provider for facility-based physicians practicing anesthesia, emergency medicine, hospital medicine, pathology, and radiology. Focused on Revenue Cycle Management, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions that solve the most complex revenue and reimbursement issues, enabling clinicians to focus on providing outstanding care to their patients and communities.

• As part of our robust Rewards & Recognition program, this role is eligible for our Ventra performance-based incentive plan, because we believe great work deserves great rewards

Job Summary

• The Accounts Receivables Escalation Specialistare primarily responsible for analyzing collections, resolving non-payables, and handling bill inquiries for more complex issues. AR Representatives are responsible for insurance payer follow-up ensuring claims are paid according to client contracts. Complies with all applicable laws regarding billing standards.

Essential Functions and Tasks

• Followsup on claim rejections and denials to ensureappropriate reimbursementfor our clients.
• Process assigned AR work lists provided by the managerin a timely manner.
• Write appeals using established guidelines to resolve claim denials with a goal of one contact resolution.
• Identifiedand resolved denied, non-paid, and/or non-adjudicatedclaims and billing issues due to coverage issues, medical record requests, and authorizations.
• Recommend accounts to be written off on Adjustment Request.
• Reports address and/or filing rule changes to the manager.
• Check the system for missing payments.
• Properly notates patient accounts.
• Review each piece of correspondence todeterminespecific problems.
• Research patient accounts.
• Reviews accounts and determines appropriate follow-up actions (adjustments, letters, phone insurance, etc.).
• Processes andfollowsup on appeals. Filesappealson claim denials.
• Scan correspondence and index to the proper account.
• Inbound/outbound calls may berequiredfor follow-up on accounts.
• Respond to insurance company claim inquiries.
• Communicates with insurance companies about the status of outstanding claims.
• Meet established production and quality standards as set by Ventra Health.
• Performs special projects and other duties as assigned.

Education and Experience Requirements

• High School Diploma or GED.
• At least one (1) year in the data entry field and one (1) year in medical billing and claims resolution preferred.
• AAHAM and/or HFMA certification preferred.
• Experience with offshore engagement and collaboration desired.

Knowledge, Skills, and Abilities

• Intermediate level knowledge of medical billing rules, such as coordination of benefits, modifiers, Medicare, and Medicaid, and understanding of EOBs.
• Become proficient in the use of billing software within 5 weeks andmaintainproficiency.
• Ability to read, understand and apply state/federal laws, regulations, and policies.
• Ability to communicate with diverse personalities in a tactful, mature, and professional manner.
• Ability to remain flexible and work within a collaborative and fast-paced environment.
• Basic use of a computer, telephone, internet, copier, fax, and scanner.
• Basic touch 10 key skills.
• Basic Math skills.
• Understand andcomply withcompany policies and procedures.
• Strong oral, written, and interpersonal communication skills.
• Strong time management and organizational skills.
• Strong knowledge of Outlook, Word, Excel (pivot tables), and database software skills.

Compensation

• Base Compensation will be based on various factors unique to each candidate including geographic location, skill set, experience, qualifications, and other job-related reasons.

• This position is also eligible for a discretionary incentive bonus in accordance with company policies.

Ventra Health

Equal Employment Opportunity (Applicable only in the US)Ventra Health is an equal opportunity employer committed to fostering a culturally diverse organization. We strive for inclusiveness and a workplace where mutual respect is paramount. We encourage applications from a diverse pool of candidates, and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, religion, sex, age, national origin, disability, sexual orientation, gender identity and expression, or veteran status. We will provide reasonable accommodations to qualified individuals with disabilities, as needed, to assist them in performing essential job functions.

Statement of AccessibilityVentra Health is committed to making our digital experiences accessible to all users, regardless of ability or assistive technology preferences. We continually work to enhance the user experience through ongoing improvements and adherence to accessibility standards. Please review at https://ventrahealth.com/statement-of-accessibility/.