Accounts Receivable Specialist (Medical)

Ensemble Health Partners; Oklahoma; Remote; USD 55,000 - 75,000; Full time

Benefits offered by this job

Tuition Reimbursement

Remote work

Bonus incentives

Job summary

Ensemble Health Partners is seeking a Sr Specialist, Accounts Receivable to handle follow up and denial activities with commercial, governmental, and other payers to secure timely reimbursement. The role mentors AR Specialist team members and analyzes denial trends to improve processes.

The position is remote with occasional travel to client sites or corporate offices as needed. A background in medical collections and strong Excel skills are required to support accurate billing and performance

Qualifications

• 1+ years of relevant experience in medical collections, AR follow-up, denials & appeals, compliance, provider relations or professional billing preferred.
• Knowledge of claims review and analysis.
• Experience working the DDE Medicare system and using payer websites to investigate claim statuses.

Responsibilities

• The Sr Specialist, Accounts Receivable performs all follow up and denial activities. Responsible for following up directly with commercial, governmental, and other payers to resolve claim payment issues, to secure appropriate and timely reimbursement and response.
• 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.

Skills

Accounts Receivable follow-up

Denials & appeals

Problem solving

Critical thinking

Communication skills

Education

High School Diploma or GED

Tools

Microsoft Excel

DDE Medicare system

Job description

Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. Customer Obsession: Bonus Incentives

Tuition Reimbursement

Responsibilities

• The Sr Specialist, Accounts Receivable performs all follow up and denial activities. Responsible for following 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 and submits technical and clinical appeals in a timely manner. Will mentor 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.
• 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.
• 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.
• Reviews escalations from other areas to AR as well as accounts that require escalation to other areas of Revenue Cycle. 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.

Ensemble Required License / Certification (Ex: CRCR) ONE CERTIFICATION PER FIELD

~ This is a remote position; however, candidates must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs require.

Qualifications

• 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. 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.
• Meet quality and productivity standards within timelines set forth in policies.
• Meet required attendance policies.
• 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.
• ~ Experience working the DDE Medicare system and using payer websites to investigate claim statuses.
• ~ Working knowledge of medical terminology and/or insurance claim terminology.

Awards & Recognition

• Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-2024
• 22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024
• Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024
• Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023
• Monster Top Workplace for Remote Work 2024

Benefits

• 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.
• Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.

Equal Employment Opportunity

It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws. Due to business, operational, payroll, and regulatory requirements, this position is limited to individuals who reside and are authorized to work within the United States. Applications generated from outside the United States will not be considered. Ensemble provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require accommodation in the application process, please contact equity;