Revenue Integrity AR Specialist

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.

About the role

The Revenue Integrity AR Specialist analyzes payer payment variances across the organization’s three core business units: Radiology, Anesthesia, and Emergency/Hospital Medicine. This role identifies and removes false positives from inventory and resolves underpayments for clients in accordance with each client’s specific payer contracts.

Responsibilities

• Identify and resolve contract variances by distinguishing false variances from those requiring action, including collaborating with internal departments, working directly with payers, and reviewing contract language and rates.
• Submit project appeals – preferably in bulk - related to contract performance variances across all specialties.
• Prepare and submit underpayment appeals using established guidelines and accurately document patient accounts in source systems.
• Process and follow up on appeals, including inbound and outbound calls as needed.
• Communicate with insurance companies regarding the status of outstanding appeals.
• Meet established production and quality standards set by Ventra Health.
• Perform special projects and other duties as assigned.

Requirements

• High School Diploma or GED. College education is preferred.
• At least three (3) years of experience in medical billing specifically resolving Accounts Receivable, contacting insurance carriers, using payer portals, completing appeals, identifying and communicating trends.
• Experience with offshore engagement and collaboration desired.

Skills

• Knowledge of State, Federal, and Managed Care regulatory guidelines.
• Knowledge of benefit insurance billing and contract management.
• Strong knowledge of Outlook, Word, Excel (pivot tables), and database software skills.
• Strong oral, written, and interpersonal communication skills.
• Strong decision-making and problem-solving skills.
• Strong time management skills.
• Basic word processing, spreadsheet, database, and presentation software skills.
• Basic mathematical skills in addition, subtraction, multiplication and division of whole numbers and fractions; computing percentages; and working with decimals.
• Ability to read, understand, and apply state/federal laws, regulations, and policies.
• Ability to exercise sound judgment and handle highly sensitive and confidential information appropriately.
• Ability to remain flexible and work within a collaborative and fast-paced environment.
• Ability to communicate with diverse personalities in a tactful, mature, and professional manner.
• Become proficient in the use of billing software within 4 weeks and maintain proficiency.
• Understand and comply with company policies and procedures.

Pay

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.