Denials Specialist

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.

Come Join Our Team!

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

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Job Summary

The Denials Specialist (Accounts Receivable (“AR”) Specialist) is primarily responsible for analyzing collections, resolving non-payables, and handling bill inquiries for more complex issues. AR Specialists 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

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.

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.

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 4 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.

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. Recruitment Agencies Ventra Health does not accept unsolicited agency resumes. Ventra Health is not responsible for any fees related to unsolicited resumes. Solicitation of Payment Ventra Health does not solicit payment from our applicants and candidates for considera