Ensemble Health Partners

Counselor

• Perform benefit education and validation
• Face to face review of inpatient benefits
• Collect inpatient, observation, and outpatient liabilities
• Accurate verification and calculation of patient liabilities
• Perform functions while meeting Ensemble Health Partners' mission and regulatory compliance requirements
• Assess and collect patient liabilities including copays, deductibles, co-insurance and balances after financial assistance
• Utilize face to face communication with patients to collect estimated patient liability
• Make follow-up phone calls to patients that are unable to make payment while in-house

Financial Counselor

Billing Specialist

• Oversee all Ensemble Health Partners Billing associates
• Monitor associates time and attendance, productivity, QA reviews, daily assigned workflows
• Ensure associate education is provided, complete annual evaluations
• Monitor all associates supporting paper biller and electronic biller functions for accuracy
• Empower staff to develop methods of process improvement

Billing Supervisor

IT Support

• Interviews uninsured/under-insured patients to determine eligibility for a state Medicaid benefit or Financial Assistance program.
• Assists with application processes to facilitate accurate and appropriate submissions.
• Follows up on submitted applications to ensure timely billing or adjustment processing.
• Reviewing all referred uninsured/under-insured patients for program eligibility opportunities.
• Effectively communicating with the patient to obtain documents that must accompany the application.
• Following submitted applications to determination point, updating applicable insurance information and ensuring timely billing or adjustment posting.
• Documenting all relevant actions and communication steps in assigned patient accounting systems.
• Maintaining working knowledge of all state and federal program requirements; shares information with colleagues and supervisors.
• Developing and maintaining proactive working relationship with county/state/federal Medicaid caseworker partners, working collaboratively with other revenue cycle departments and associates.

Public Benefit Specialist

• Interviews uninsured/under-insured patients to determine eligibility for a state Medicaid benefit or location Financial Assistance program.
• Assists with application processes to facilitate accurate and appropriate submissions.
• Follows-up on submitted applications to insure timely billing or adjustment processing.
• Reviewing all referred uninsured/under-insured patients for program eligibility opportunities, initializing and coordinating the application process to facilitate accurate and appropriate submissions.
• Effectively communicating with the patient to obtain documents that must accompany the application.
• Following submitted applications to determination point, updating applicable insurance information and ensuring timely billing or adjustment posting.
• Documenting all relevant actions and communication steps in assigned patient accounting systems.
• Maintaining working knowledge of all state and federal program requirements; shares information with colleagues and supervisors.
• Developing and maintaining proactive working relationship with county/state/federal Medicaid caseworker partners, working collaboratively with other revenue cycle departments and associates.
• Other job duties as assigned.

Analyst

• Communicate directly with payors to follow up on outstanding underpayments, file underpayment appeals with payors, resolve account variance and ensure timely and accurate recovery of underpayments.
• Identify root cause of underpayments, denials, and delayed payments to clients.
• Work with the client team to identify, document, and address root causes of issues in the A/R.
• Maintain a thorough understanding of applicable state and federal insurance regulations as well as payor specific requirements, taking actions on underpayments accordingly.
• Document all activity accurately with all pertinent information in the client’s host system, Ensemble IQ, or other appropriate tracking system.
• Demonstrate initiative and resourcefulness by making recommendations and communicating trends and issues to management.
• Operate as a strong problem solver and critical thinker to resolve underpayments.
• Meet all productivity and quality standards as established by Ensemble and Revenue Recovery leadership.
• Compile and analyze data to identify underpayments, and trends in the underpayments and report to leadership findings in a timely and consistent manner.
• Work collaboratively with other departments, including Managed Care, Billing, Coding, Revenue Integrity, and Payor Strategy.
• Work multiple projects, reports, and tasks efficiently in a fast-paced, KPI-driven atmosphere autonomously.

Revenue Recovery Associate Analyst I

Accounts Receivable

• Supervises the daily workflow of the department, monitoring progress to identify trends in denied payments by insurance companies, determining trends in unpaid claims and remediation solutions.
• Reviews Leadership No Touch Report if available to ensure all high dollar accounts are reviewed monthly.
• Reviews action logs daily and completed action logs pending to be verified.
• Conducts team huddles to efficiently cover new or evolving training focuses to encourage and develop team members, including sharing identified trends and solutions on unpaid and denied claims.
• Leads Team DIBS meetings and provides recap to team and leaders.
• Ensures adherence to the departmental budget, including overtime.
• Prepare monthly reports as requested.
• Establishes departmental goals with the staff to optimize performance and meet budgetary goals while improving operations to increase customer satisfaction and meet financial goals of the organization.
• Ensure all team members meet productivity and quality standards.
• Meets with all associates 1:1 monthly to review current performance.
• Maintains and communicates any associate behavior, performance and attendance issues that may constitute a verbal or a correction action and/or performance improvement plan.
• Ensures timely completion and documents conversations in Workday.
• Reviews assigned associate's time management and approve timecards for payroll processing in a timely manner.
• Reviews Roster in Workday to ensure correct client, cost center and work location assignment.
• Collects, interprets, and communicates performance data using various tools and systems, while also using this data to make decisions on how to achieve performance goals.
• Works with internal and external customers to make key decisions, impacting either the organization or an individual patient.
• Works closely with ancillary departments to establish and maintain positive relations to ensure revenue cycle goals are achieved.

Accounts Receivable Supervisor

Manager

• Responsible for planning, developing, organizing, and managing the Patient Access department
• Responsible for the performance and effectiveness of department(s)
• Coaching and development of all staff performing these functions
• Implementing short and long-term plans and objectives to improve customer service and collect quality information
• Provide leadership and contribute to the revenue cycle and organizational goals
• Work closely with the Director of Patient Access to align processes and procedures with Ensemble Health Partners policies

Patient Access Manager

Medical Billing and Coding

• Code claims directly from the medical record/operative report according to coding guidelines.
• Accurate and timely completion of work queues as assigned.
• Track and identify trends within charge review and follow up work queues and assist leadership in the resolution of those trends and/or educational needs.
• Assists with research of denied claims.
• Maintains compliance with established corporate and departmental policies and procedures, quality improvement program, customer service and productivity expectations.
• Must be able to achieve individual quality and productivity performance metrics in daily duties as set by coding leadership.
• Provide and/or assist with provider education, as well as the development of educational tools.
• Communicates professionally with physicians, management, and peers.
• Participates in all educational activities including coding meetings/calls necessary to provide information relating to coding and compliance.
• Remains abreast of changes to current payer guidelines, Correct Coding Initiative edits, and Local/National Coverage Determinations for accuracy in Coding and mentors team members regarding coding guidelines and accuracy.
• Assists with training of other coders.
• Takes initiative for learning new skills and willingness to participate and share expertise on projects, committees and other activities as deemed appropriate.
• Demonstrates personal responsibility for job performance.
• Extensive knowledge/experience in physician coding with expert knowledge in a specific coding specialty and the ability to provide education/support to coding team and providers.

Specialized Coder – Cardiology, Vascular, CVTS

Auditor

• Perform documentation and coding audits for all acute inpatient services for clients
• Identify coding errors, compliance, and educational opportunities
• Optimize reimbursement by ensuring that diagnosis/procedure codes and supporting documentation accurately support the services rendered
• Perform independent reviews, interpret medical records, and apply in-depth knowledge of coding principles
• Conduct DRG (ex. MS, APR, Tricare) coding and clinical reviews
• Maintain productivity and quality goals as set by audit leaders
• Write clear, accurate and concise recommendations
• Ensure acute inpatient coding audits are completed accurately and timely

DRG Validation Coding Auditor

Financial Planning and Analysis

• Provide personalized guidance to help patients understand and manage healthcare-related financial obligations
• Review benefits, estimate out-of-pocket costs, and facilitate payment arrangements
• Address billing and coverage inquiries and maintain accurate account documentation
• Monitor trends, prepare operational reports, and support process improvement initiatives

Senior Financial Navigating Specialist

• Performs all billing, correspondence, and scanning activities across the organization
• Managing client billing and ensuring procedures are billed according to contracts
• Reviewing and updating client statements as necessary
• Printing and mailing all paper and secondary claims
• Scanning documents to patient accounts
• Reviewing correspondence and following up as needed
• Meeting the mission and goals of the organization
• Meeting the regulatory compliance requirements

Physician Billing Associate Specialist

Engineer

• Responsible for system integration, data ingestion, transformation, validation, and maintenance
• Design, build, and support HL7 interfaces using the Infor Cloverleaf Interface Engine
• Develop and implement HL7/EDI interfaces and REST APIs
• Perform workflow analysis and documentation
• Interact with multi-disciplinary teams and communicate effectively

Data Engineer

• Interviews uninsured/under-insured patients to determine eligibility for a state Medicaid benefit or location Financial Assistance program.
• Assists with application processes to facilitate accurate and appropriate submissions.
• Follows-up on submitted applications to ensure timely billing or adjustment processing.
• Reviewing all referred uninsured/under-insured patients for program eligibility opportunities, initializing and coordinating the application process to facilitate accurate and appropriate submissions.
• Effectively communicating with the patient to obtain documents that must accompany the application.
• Following submitted applications to determination point, updating applicable insurance information and ensuring timely billing or adjustment posting.
• Documenting all relevant actions and communication steps in assigned patient accounting systems.
• Maintaining working knowledge of all state and federal program requirements; shares information with colleagues and supervisors.
• Developing and maintaining proactive working relationship with county/state/federal Medicaid caseworker partners, working collaboratively with other revenue cycle departments and associates.

• Interviews uninsured/under-insured patients to determine eligibility for a state Medicaid benefit or Financial Assistance program.
• Assists with application processes to facilitate accurate and appropriate submissions.
• Follows-up on submitted applications to ensure timely billing or adjustment processing.
• Reviewing all referred uninsured/under-insured patients for program eligibility opportunities, initializing and coordinating the application process.
• Effectively communicating with the patient to obtain documents that must accompany the application.
• Following submitted applications to determination point, updating applicable insurance information and ensuring timely billing or adjustment posting.
• Documenting all relevant actions and communication steps in assigned patient accounting systems.
• Maintaining working knowledge of all state and federal program requirements; shares information with colleagues and supervisors.
• Developing and maintaining proactive working relationship with county/state/federal Medicaid caseworker partners, working collaboratively with other revenue cycle departments and associates.

• Interview uninsured/under-insured patients to determine eligibility for a state Medicaid benefit or Financial Assistance program.
• Assist with application processes to facilitate accurate and appropriate submissions.
• Follow-up on submitted applications to ensure timely billing or adjustment processing.
• Review all referred uninsured/under-insured patients for program eligibility opportunities.
• Communicate effectively with the patient to obtain documents that must accompany the application.
• Maintain working knowledge of all state and federal program requirements; share information with colleagues and supervisors.
• Develop and maintain proactive working relationships with county/state/federal Medicaid caseworker partners.