Accounts Receivable Escalation Specialist

Summary

Ventra Health is a business solutions provider focused on revenue cycle management for facility-based physicians and healthcare organizations. The Accounts Receivable Escalation Specialist analyzes collections, resolves complex billing and claim issues, handles payer inquiries, and follows up on denials and appeals to support appropriate reimbursement.

Responsibilities

• Follows up on claim rejections and denials to ensure appropriate reimbursement for our clients
• Process assigned AR work lists provided by the manager in a timely manner
• Write appeals using established guidelines to resolve claim denials with a goal of one contact resolution
• Identified and resolved denied, non-paid, and/or non-adjudicated claims 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 to determine specific problems
• Research patient accounts
• Reviews accounts and determines appropriate follow-up actions (adjustments, letters, phone insurance, etc.)
• Processes and follows up on appeals. Files appeals on claim denials
• Scan correspondence and index to the proper account
• Inbound/outbound calls may be required for 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

Skills

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

Qualifications

Must Haves

• High School Diploma or GED
• 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 and maintain proficiency
• 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 and comply with company 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
• At least one (1) year in the data entry field and one (1) year in medical billing and claims resolution

Nice to Haves

• AAHAM and/or HFMA certification preferred
• Experience with offshore engagement and collaboration desired

Benefits

• Eligible for Ventra's performance-based incentive plan
• Referral bonus for referring a friend
• Eligible for a discretionary incentive bonus in accordance with company policies