revenue cycle associate

Innovive Health

<b>FLSA Classification:</b> Non-Exempt
<br><b>Department:</b> Finance
<br><b>Reports To:</b> Sr. Manager of Revenue Cycle
<br><b>Direct Reports:</b> N/A
<br><br>
<b>POSITION SUMMARY:</b><br>
The Revenue Cycle Associate supports a high performing Revenue Cycle Department. The individual filling this position will be an ambitious hands-on problem solver and effective communicator that will support the achievements of the team. The role may include but is not limited to the following: following up on denials and collections, posting payments, or any other projects as needed.
<br><br>
<b>RESPONSIBILITIES:</b><br>
<ul>
<li>Processes payments and denials within 48 business hours of receipt from insurers.</li>
<li>Documents denial reasons within the EMR using clear, concise language.</li>
<li>Reconciles the Cash Posting Journal/Deposits Report from each of our EMRs to the bank deposits.</li>
<li>Ability to comprehend and work with various payers’ remittance advices/explanations of benefits.</li>
<li>Understands the reason for denials or partial payments on remittance advices/explanations of benefits.</li>
<li>Research denials and partial payments to determine if further action is needed.</li>
<li>Research payers’ payment policies when necessary.</li>
<li>Contacts payers and patients to obtain payment on outstanding accounts.</li>
<li>Navigates through software systems efficiently.</li>
<li>Notifies appropriate parties if payment is not received or payer fails to respond.</li>
<li>Records information about financial status of accounts and status of collection efforts.</li>
<li>Prepares collections reports.</li>
<li>Requests timely adjustments and write offs.</li>
<li>Assists with related special projects and perform other related duties as assigned by management.</li>
<li>Adheres to all home health care regulations including CMS and multiple state Medicaid programs.</li>
<li>Adheres to agency’s policies and procedures.</li>
<li>Performs other duties as assigned.</li>
</ul>
<b>COMPETENCIES:</b><br>
<ul>
<li>Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.</li>
<li>Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.</li>
<li>Analytical - Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data; Designs workflows and procedures.</li>
<li>Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.</li>
<li>Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.</li>
<li>Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.</li>
</ul>
<b>REQUIRED QUALIFICATIONS:</b><br>
<ul>
<li>Associate’s degree in business or 1-2 years of related work experience.</li>
<li>Intermediate level in Microsoft Office, Excel, Word, and Outlook</li>
<li>Ability to perform diversified clerical functions and intermediate level accounting procedures</li>
</ul>
<b>PREFERRED EDUCATION AND EXPERIENCE:</b><br>
<ul>
<li>Previous experience using HealthWyse</li>
<li>Previous experience with the MassHealth Provider Online Service Center (POSC)</li>
</ul>
<b>PHYSICAL DEMANDS AND OFFICE ENVIRONMENT:</b><br>
<ul>
<li>Occasionally required to stand.</li>
<li>Occasionally required to walk.</li>
<li>Frequently required to sit.</li>
<li>Continually required to use hands and fingers.</li>
<li>Occasionally required climb, balance, bend, stoop, kneel or crawl.</li>
<li>Occasionally required to lift/push light weights (less than 25 pounds).</li>
</ul>
<b>TRAVEL REQUIREMENTS:</b><br>
<ul>
<li>Ability to travel locally by car to office(s), events, meetings, etc., as needed (approximately 5% or less of the time).</li>
</ul>
Innovive Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Revenue Cycle Associate

CHRISTUS Health

<div><b>Description</b><p><br>
Summary:</p>
<p>The associate is responsible for the duties and services that are of a support nature to the Revenue Cycle division of CHRISTUS Health. The associate ensures that all processes are performed in a timely and efficient manner. The primary purpose of this Job is to ensure account resolution and reconciliation of outstanding balances for CHRISTUS Health patient accounts. The Job works in a cooperative team environment to provide value to internal and external customers.
<br>
The associate carries out his/her duties by adhering to the highest standards of ethical and moral conduct, acts in the best interest of CHRISTUS Health, and fully supports CHRISTUS Health's Mission, Philosophy, and core values of Dignity, Integrity, Compassion, Excellence, and Stewardship.</p>
<p>Responsibilities:</p><br>
<ul><li>Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
</li><li>Performs Revenue Cycle functions in a manner that meets or exceeds CHRISTUS Health's key performance metrics.
</li><li>Ensures PFS departmental quality and productivity standards are met.
</li><li>Collects and provides patient and payor information to facilitate account resolution.
</li><li>Responds to all types of account inquiries through written, verbal, or electronic correspondence.
</li><li>Maintains payor-specific knowledge of insurance and self-pay billing and follow-up guidelines and regulations for third-party payers. Maintains working knowledge of all functions within the Revenue Cycle.
</li><li>Responsible for professional and effective written and verbal communication with both internal and external customers in order to resolve outstanding questions for account resolution.
</li><li>Meets or exceeds customer expectations and requirements, and gains customer trust and respect.
</li><li>Compliant with all CHRISTUS Health, payer, and government regulations.
</li><li>Exhibits a strong working knowledge of CPT, HCPCS, and ICD-10 coding regulations and guidelines.
</li><li>Appropriately documents patient accounting host system or other systems utilized by PFS in accordance with policy and procedures.
</li><li>Provide continuous updates and information to the PFS Leadership Team regarding errors, issues, and trends related to activities affecting productivity, reimbursement, payment delays, and/or patient experience.
</li><li>Must have professional and effective written and verbal communication.
</li></ul><ul><li>Billing
</li><li>Review and work on claim edits.
</li><li>Works payor rejected claims for resubmission.
</li><li>Works reports and billing requests.
</li><li>Demonstrates strong knowledge of standard bill forms and filing requirements.
</li><li>Exhibits and understanding of electronic claims editing and submission capabilities.
</li></ul><ul><li>Collections
</li><li>Collect balances due from payors ensuring proper reimbursement for all services.
</li><li>Identifies and forwards proper account denial information to the designated departmental liaison. Dedicated efforts to ensure a proper denial resolution and timely turnaround.
</li><li>Maintain an active knowledge of all collection requirements by payors.
</li><li>Works collector queue daily utilizing appropriate collection system and reports.
</li><li>Demonstrates knowledge of standard bill forms and filing requirements.
</li><li>Identify and resolve underpayments with the appropriate follow-up activities within payor timely guidelines.
</li><li>Identify and resolve credit balances with the appropriate follow-up activities within payor timely guidelines.
</li><li>Identify and communicate trends impacting account resolution.
</li></ul><ul><li>Cash Reconciliation
</li><li>Ensures all payments are retrieved and posted accurately and timely through reconciliation of patient accounting system and bank statement.
</li><li>Researches submitted cash payments by verifying patient account numbers and appropriate facilities.
</li><li>Monitor and performs cash reconciliation to identify cash posting errors and ensures all receipts are applied and reconciles to daily bank deposit and monthly bank statements.
</li><li>Review and post cash corrections, including resolving patient complaints and inquiries from PFS, Finance, Facilities, and Vendor Partners.
</li><li>Resolve and Research unapplied cash, including continuous follow-up until payment identification is made for application of payment or refund.</li></ul>
<p>Job Requirements:</p><br>
<p><b>Education/Skills</b></p>
<ul><li>HS Diploma or equivalent years of experience required.
</li><li>Post HS education preferred.
</li></ul><p><b>Experience</b></p>
<ul><li>3-5 years of experience preferred.
</li><li>Experience working within a multi-facility hospital business office environment preferred.
</li><li>College education, previous Insurance Company claims experience and/or health care billing trade school education may be considered in lieu of formal hospital experience.
</li><li>Experience working with inpatient and outpatient billing requirements of UB-04 and HCFA 1500 billing forms preferred.
</li></ul><p><b>Licenses, Registrations, or Certifications</b></p>
<ul><li>None required.</li></ul><br>
<p></p>
<p>Work Schedule:</p><br>
<p>8AM - 5PM Monday-Friday</p>
<p>Work Type:</p><br>
<p>Full Time</p></div>

Patient Financial Representative Senior - Patient Financial Services

<div><b>Description</b><p><br>
Summary:</p>
<p>The associate is responsible for the duties and services that are of a support nature to the Revenue Cycle division of CHRISTUS Health. The associate ensures that all processes are performed in a timely and efficient manner. The primary purpose of this Job is to ensure account resolution and reconciliation of outstanding balances for CHRISTUS Health patient accounts. The Job works in a cooperative team environment to provide value to internal and external customers.
<br>
The associate carries out his/her duties by adhering to the highest standards of ethical and moral conduct, acts in the best interest of CHRISTUS Health, and fully supports CHRISTUS Health's Mission, Philosophy, and core values of Dignity, Integrity, Compassion, Excellence, and Stewardship.</p>
<p>Responsibilities:</p><br>
<ul><li>Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
</li><li>Performs Revenue Cycle functions in a manner that meets or exceeds CHRISTUS Health's key performance metrics.
</li><li>Ensures PFS departmental quality and productivity standards are met.
</li><li>Collects and provides patient and payor information to facilitate account resolution.
</li><li>Responds to all types of account inquiries through written, verbal, or electronic correspondence.
</li><li>Maintains payor-specific knowledge of insurance and self-pay billing and follow-up guidelines and regulations for third-party payers. Maintains working knowledge of all functions within the Revenue Cycle.
</li><li>Responsible for professional and effective written and verbal communication with both internal and external customers in order to resolve outstanding questions for account resolution.
</li><li>Meets or exceeds customer expectations and requirements, and gains customer trust and respect.
</li><li>Compliant with all CHRISTUS Health, payer, and government regulations.
</li><li>Exhibits a strong working knowledge of CPT, HCPCS, and ICD-10 coding regulations and guidelines.
</li><li>Appropriately documents patient accounting host system or other systems utilized by PFS in accordance with policy and procedures.
</li><li>Provide continuous updates and information to the PFS Leadership Team regarding errors, issues, and trends related to activities affecting productivity, reimbursement, payment delays, and/or patient experience.
</li><li>Must have professional and effective written and verbal communication.
</li></ul><ul><li>Billing
</li><li>Review and work on claim edits.
</li><li>Works payor rejected claims for resubmission.
</li><li>Works reports and billing requests.
</li><li>Demonstrates strong knowledge of standard bill forms and filing requirements.
</li><li>Exhibits and understanding of electronic claims editing and submission capabilities.
</li></ul><ul><li>Collections
</li><li>Collect balances due from payors ensuring proper reimbursement for all services.
</li><li>Identifies and forwards proper account denial information to the designated departmental liaison. Dedicated efforts to ensure a proper denial resolution and timely turnaround.
</li><li>Maintain an active knowledge of all collection requirements by payors.
</li><li>Works collector queue daily utilizing appropriate collection system and reports.
</li><li>Demonstrates knowledge of standard bill forms and filing requirements.
</li><li>Identify and resolve underpayments with the appropriate follow-up activities within payor timely guidelines.
</li><li>Identify and resolve credit balances with the appropriate follow-up activities within payor timely guidelines.
</li><li>Identify and communicate trends impacting account resolution.
</li></ul><ul><li>Cash Reconciliation
</li><li>Ensures all payments are retrieved and posted accurately and timely through reconciliation of patient accounting system and bank statement.
</li><li>Researches submitted cash payments by verifying patient account numbers and appropriate facilities.
</li><li>Monitor and performs cash reconciliation to identify cash posting errors and ensures all receipts are applied and reconciles to daily bank deposit and monthly bank statements.
</li><li>Review and post cash corrections, including resolving patient complaints and inquiries from PFS, Finance, Facilities, and Vendor Partners.
</li><li>Resolve and Research unapplied cash, including continuous follow-up until payment identification is made for application of payment or refund.</li></ul>
<p>Job Requirements:</p><br>
<p><b>Education/Skills</b></p>
<ul><li>HS Diploma or equivalent years of experience required.
</li><li>Post HS education preferred.
</li></ul><p><b>Experience</b></p>
<ul><li>3-5 years of experience preferred.
</li><li>Experience working within a multi-facility hospital business office environment preferred.
</li><li>College education, previous Insurance Company claims experience and/or health care billing trade school education may be considered in lieu of formal hospital experience.
</li><li>Experience working with inpatient and outpatient billing requirements of UB-04 and HCFA 1500 billing forms preferred.
</li></ul><p><b>Licenses, Registrations, or Certifications</b></p>
<ul><li>None required.</li></ul><br>
<p></p>
<p>Work Schedule:</p><br>
<p>5 Days - 8 Hours</p>
<p>Work Type:</p><br>
<p>Full Time</p></div>

Clearwave Mental Health

<p><b>Company Overview</b><br/>Clearwave Mental Health is dedicated to providing compassionate, personalized, and innovative mental health treatment to our community. Led by experienced medical professionals, we are committed to advancing mental health care through cutting-edge therapies and comprehensive services.</p><p><b>Job Summary</b><br/>We are seeking a motivated and detail-oriented Revenue Cycle Specialist to join our dynamic team. In this vital role, you will manage the full revenue cycle, from insurance verification and claims submission through payment posting, denials management, and patient billing support. This is an in-person, full-time role in Poughkeepsie, NY.</p><p><b>Responsibilities</b></p><ul><li>Manage the end-to-end revenue cycle: verify insurance coverage, submit claims, track status, resolve denials, and follow up for payment.</li><li>Process insurance claims accurately and efficiently through our billing system.</li><li>Post insurance payments, reconcile accounts, and monitor outstanding balances.</li><li>Contact insurance companies to resolve claim issues, including managed Medicaid plans, prior authorizations, and behavioral health claim nuances.</li><li>Collaborate with providers and front office teams to support specialized services, such as TMS and Spravato treatments.</li><li>Communicate professionally with patients regarding balances and billing questions.</li><li>Ensure all patient information is secure and that all communications and disclosures are HIPAA compliant.</li><li>Perform any other tasks or responsibilities as needed and communicated by the Executive Team.</li></ul><p><b>Requirements</b></p><ul><li>Proven experience in medical billing, coding, or revenue cycle management within a healthcare setting.</li><li>Demonstrated experience with complex denials, appeals, and payer follow-up.</li><li>Familiarity with major commercial payers (BCBS, United Healthcare, Aetna, etc.) and Medicaid/Medicare plans.</li><li>Proficiency with EHR/EMR systems and billing platforms.</li><li>Knowledge of CPT/HCPCS and ICD-10 coding standards.</li><li>Strong communication skills for interacting with patients, providers, and insurance representatives.</li><li>Detail-oriented, organized, and able to manage multiple claims efficiently.</li><li>Prior experience in mental health or behavioral health settings is a plus.</li></ul><p><b>Preferred: </b></p><ul><li>Associate or bachelor&rsquo;s degree in health administration, accounting, or related field.</li><li>Hands-on medical billing/claims management experience, preferably in mental health or outpatient care.</li></ul><p>Join us as a Revenue Cycle Specialist and be a key player in delivering quality mental health services while ensuring our financial operations run smoothly!</p><p>Pay: From $23.00 per hour</p><p>Benefits:</p><ul><li>401(k)</li><li>Dental insurance</li><li>Health insurance</li><li>Paid time off</li></ul><p>Work Location: In person</p>

Revenue Cycle Specialist

Ensemble Health Partners

<div><div>Thank you for considering a career at Ensemble!</div><div></div><div>
Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country.</div><div></div><div>
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. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference!</div><div></div><div>
O.N.E Purpose:</div><ul><li><div>
Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations.</div></li><li><div>
Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation.</div></li><li><div>
Striving for Excellence: Execute at a high level by demonstrating our &ldquo;Best in KLAS&rdquo; Ensemble Difference Principles and consistently delivering outstanding results.</div></li></ul><div></div><div>
The Opportunity:</div><div></div><div>
CAREER OPPORTUNITY OFFERING:</div><ul><li>
Bonus Incentives</li><li>
Paid Certifications</li><li>
Tuition Reimbursement</li><li>
Comprehensive Benefits</li><li>
Career Advancement</li></ul><div></div><div>
The salary range for this position is $69,000.00 to $104,100.00. Final offers are based on experience and geo zone.</div><div></div><div>
The Denial Prevention Process Improvement Advisor leads the performance of deep dive analysis on clinical and technical denials for his or her respective client, utilizing multiple analytics tools (including parsed 835 data, Epic BDC records, Access databases/SQL) to identify patterns and trends relative to acute denials. The Denial Prevention Process Improvement Advisor applies high level problem-solving skills to perform root cause analysis on denied accounts as transactions and extrapolates those causes across large volumes identified as denial trends for assigned facilities. The Denial Prevention Process Improvement Advisor then uses process improvement expertise and persuasion skills to guide and influence subject matter experts through assessments of operations and preparation of policies, procedures, and tip sheets that assist in remedying the root cause(s). The Denial Prevention Process Improvement Advisor is client-facing and oversees completion of denial prevention committee reports and summaries for assigned hospitals, attends monthly denial prevention committee meetings, liaises as primary contact for assigned client on revenue cycle related-denials issues, establishes and maintains client relationships to drive best practice implementations, and utilizes sound judgment and experience to aggregate and advance team recommendations for correcting underlying issues impacting denials. This is done in facilitation and addition to an expectation of contributing to the overarching goals of the Payment Integrity Team and Ensemble as a whole.</div><div></div><div>
Essential Job Functions:</div><ul><li>
Provides relevant guidance and works to resolve issues escalated by Revenue Cycle Site Directors, and other participants related to denial prevention</li></ul><ul><li>
Leads monthly Denial Prevention onsite week kick-off and close-out meetings with assigned client leadership, covering necessary information relative to identified trends, progress from prior actions, and next steps.</li></ul><ul><li>
Establishing strong relationships with appropriate stakeholders/committee members, including Finance Leadership, Revenue Cycle, Managed Care, and hospital ancillary department heads</li></ul><ul><li>
Oversees documentation and trends prevention-related findings into defined templates, initiating or creating reports or summaries as needed.</li></ul><ul><li>
Leads reviews using all patient accounting, host, Epic and related systems used across their client to verify and summarize trends concisely and actionably.</li></ul><ul><li>
Aggregates and provides strategic advisory perspective related to process improvement and quality in assessment of the root cause issues creating denials by working with the subject-matter experts and applicable owners to make recommendations to remedy process, system, and education issues.</li></ul><ul><li>
Creates materials and trains denial prevention staff, revenue cycle site directors, committee members, and revenue cycle staff as necessary on denials-related trends and issues impacting their client.</li></ul><ul><li>
Performs other duties as assigned</li></ul><div></div><div>
Required Minimum Education:</div><div>
4 year/ Bachelors Degree</div><div></div><div>
Specialty/Major:</div><div>
Healthcare administration, Business or related discipline</div><div></div><div>
Preferred Education:</div><div>
Graduate Degree (Masters)</div><div></div><div>
Other Knowledge, Skills and Abilities Required:</div><ul><li>Project Work, Intermediate Excel &amp; Access Skills</li></ul><div></div><ul><li><br>
Project Management, Data Analytics</li></ul><div></div><ul><li>Demonstrated advanced usage of AI and the management of teams using AI to lean in to process and technological improvements, to include the exploration, experimentation, and application of AI.</li></ul><div></div><ul><li>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.</li></ul><div></div><div>
Licensure/Certification Preferred:</div><ul><li>Certified Specialist Managed Care (CSMC); LEAN Six Sigma Black Belt</li><li>Certified Revenue Cycle Representative: (CRCR)</li></ul><div></div><div>
Join an award-winning company</div><div></div><div>
Five-time winner of &ldquo;Best in KLAS&rdquo; 2020-2022, 2024-2025</div><div>
Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-2024</div><div>
22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024</div><div>
Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024</div><div>
Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023</div><div>
Energage Top Workplaces USA 2022-2024</div><div>
Fortune Media Best Workplaces in Healthcare 2024</div><div>
Monster Top Workplace for Remote Work 2024</div><div>
Great Place to Work certified 2023-2024</div><ul><li><div>
Innovation</div></li><li><div>
Work-Life Flexibility</div></li><li><div>
Leadership</div></li><li><div>
Purpose + Values</div></li></ul><div></div><div>
Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include:</div><ul><li><div>
Associate Benefits &ndash; 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.</div></li><li><div>
Our Culture &ndash; Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation.</div></li><li><div>
Growth &ndash; We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.</div></li><li><div>
Recognition &ndash; We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.</div></li></ul><div></div><div>
Ensemble is an equal employment opportunity employer. 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. Ensemble also prohibits harassment of applicants or employees based on any of these protected categories.</div><div></div><div>
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 <div>TA@ensemblehp.com</div>.</div><div></div><div>
This posting addresses state specific requirements to provide pay transparency. Compensation decisions consider many job-related factors, including but not limited to geographic location; knowledge; skills; relevant experience; education; licensure; internal equity; time in position. A candidate entry rate of pay does not typically fall at the minimum or maximum of the role&rsquo;s range.</div><div></div><div><div>
EEOC &ndash; Know Your Rights</div><br>
<div>FMLA Rights - English</div></div><div><div>
La FMLA Espa&ntilde;ol</div></div><div><div>
E-Verify Participating Employer</div> (English and Spanish)</div><div><div>
Know your Rights</div></div></div>

Senior Denial Prevention Process Improvement Advisor

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