Rejections Specialist

Company Overview

Ventra Health is a premier solutions provider catering to facility-based physicians specializing in anesthesia, emergency medicine, hospital medicine, pathology, and radiology. The company's primary focus lies in Revenue Cycle Management, collaborating with private practices, hospitals, health systems, and ambulatory surgery centers. Ventra offers transparent, data-driven strategies designed to tackle complex revenue and reimbursement challenges, allowing clinicians to concentrate on delivering exceptional patient care.

Job Summary

The Rejections Specialist is tasked with analyzing collections, addressing non-payable claims, and managing billing inquiries related to more complex cases. This specialist ensures insurance payers process claims in line with client contracts while adhering to all relevant billing regulations.

Key Responsibilities

• Investigate claim rejections and denials to secure appropriate reimbursements on behalf of clients.
• Efficiently process assigned accounts receivable work lists as directed by management.
• Compose appeals following established protocols aiming for single-contact resolution of claim denials.
• Identify and rectify denied, unpaid, or unprocessed claims due to coverage, medical record requests, or authorization challenges.
• Recommend accounts for write-off via Adjustment Requests where appropriate.
• Notify management regarding any changes in address or filing rules.
• Check for missing payments within the system and document patient accounts accurately.
• Assess correspondence to diagnose specific problems and perform detailed patient account research.
• Determine and execute suitable follow-up actions including adjustments, correspondence, or insurance follow-ups.
• Manage appeal filings and follow-ups on claim denials.
• Make inbound and outbound calls as needed for account follow-ups.
• Respond to inquiries from insurance companies and communicate claim statuses effectively.
• Adhere to established production and quality standards set by the company.
• Access online portals to obtain Explanation of Benefits (EOBs).
• Undertake special projects and additional duties as assigned.

Qualifications & Experience

• Minimum of a High School Diploma or equivalent credential.
• At least two years of experience posting insurance payments in healthcare settings.
• Preferred two years experience interpreting insurance Explanation of Benefits statements.
• Certifications such as AAHAM or HFMA are advantageous.
• Experience collaborating with offshore teams is a plus.

Skills & Abilities

• Intermediate knowledge of medical billing rules including coordination of benefits, modifiers, Medicare, and Medicaid, plus an understanding of EOBs.
• Capability to attain billing software proficiency within four weeks and sustain it.
• Ability to interpret and apply state and federal laws, regulations, and policies.
• Skill in professional and tactful communication with diverse personalities.
• Flexibility and adaptability in a collaborative, dynamic work environment.
• Strong aptitude in balancing accounts and performing reconciliations.
• Competence with 10-key calculators.
• Excellent oral, written, and interpersonal communication skills.
• Proficiency in mathematical concepts and time management.
• Outstanding organizational abilities.

Compensation & Benefits

• Base salary is competitive and individualized based upon factors such as geographic location, experience, qualifications, and skill set.
• Eligibility for a performance-based discretionary incentive bonus under company policies.
• Participation in a comprehensive Rewards & Recognition program that includes a referral bonus opportunity.

Additional Information

Ventra Health is an equal opportunity employer committed to diversity and inclusion, ensuring fair treatment regardless of race, color, ethnicity, religion, sex, age, national origin, disability, sexual orientation, gender identity, or veteran status. Reasonable accommodations are provided for individuals with disabilities to support essential job functions.

The company does not accept unsolicited agency resumes and is not responsible for any fees related to such submissions. Candidates should be cautious of fraudulent representations claiming to associate with Ventra Health and verify all official communications through direct company channels.

Ventra Health is dedicated to digital accessibility for all users, continuously improving platform experiences to meet accessibility standards.