Follow-Up Associate I Jobs

R1 is a leading provider of technology-enabled revenue cycle management services which transform and solve challenges across health systems, hospitals and physician practices. Headquartered in Chicago, R1 is publicly-traded organization with employees throughout the US and international locations.

Our mission is to be the one trusted partner to manage revenue, so providers and patients can focus on what matters most. Our priority is to always do what is best for our clients, patient’s and each other. With our proven and scalable operating model, we complement a healthcare organization’s infrastructure, quickly driving sustainable improvements to net patient revenue and cash flows while reducing operating costs and enhancing the patient experience.

The Follow Up Associate will be responsible for investigating and working denial accounts, accounts rejected by the payor or no response. Will apply appropriate methods and techniques as established internally to resolve applicable issues, follows through with unresolved accounts, provides feedback to the appropriate staff on where the process went wrong, and keeps staff educated on all current trends in the appeals arena. Utilizes computer systems/programs, processes, policies and procedures as they apply to the positions entailed duties and be able to trouble-shoot issues as they arise within the assigned specialization group. In addition, this position is required to learn how to conduct research analysis and work closely with third party payers to answer relevant questions and obtain appropriate information in pursuit of resolving unpaid claims. Follow Up Associates must be assessed as being resourceful and having extensive knowledge in area applicable to the assigned specialization group. Acts under direct supervision while learning to make complex decisions within the scope of this position. This position primarily works with Medicare.

Responsibilities:

• Work closely with Appeals staff to create and establish appropriate appeal letters
• Other duties as assigned
• Complete various projects as assigned by management
• Meet or exceed daily production goals as determined/assigned by management with high quality
• Works closely with third party payers to resolve unpaid claims in proving medical necessity of the patient's admission
• Resolve insurance claim denials by diagnosing the root cause of the clearing house rejection, denial or no response obtaining additional information from various sources, updating accounts, and refiling claims
• Reads and interprets expected reimbursement information from EOB's and learns legal parameters pertaining to all State and Federal Laws that pertain to the plan benefits pertaining to the EOB
• Work with internal department and clients to obtain medical records requested by the payer and timely submit them to the payer
• Ensure compliance with all company confidentiality policies including patient information, client information and team member information encountered while performing job duties
• Maintains and follows all HIPAA and confidentiality requirements
• Create and submit claim appeals according to payer guidelines
• Communicate trends and opportunities for improvement to management
• Investigates and works to resolve denials, rejects, or no response utilizing knowledge of workflows, calling the payor, AR billing experience, and EDI billing
• Work payer correspondence

Required Qualifications:

• Demonstrated knowledge in the health insurance industry (Commercial Insurances, Medicare, Medicaid); health claims billing and/or Third-Party contracts, is preferred
• Minimum of 1 year of experience in the healthcare field is required
• High School diploma
• Demonstrated excellent analytical, fact-finding, problems solving and organizational skills as well as the ability to communicate, both verbally and in writing with staff, patients, and insurance plan administrators
• Experience with Medicare is preferred
• Experience in the Healthcare Revenue cycle is preferred
• Demonstrated ability to work successfully in a team setting

Working in an evolving healthcare setting, we use our shared expertise to deliver innovative solutions. Our fast-growing team has opportunities to learn and grow through rewarding interactions, collaboration and the freedom to explore professional interests.

Our associates are given valuable opportunities to contribute, to innovate and create meaningful work that makes an impact in the communities we serve around the world. We also offer a culture of excellence that drives customer success and improves patient care. We believe in giving back to the community and offer a competitive benefits package. To learn more, visit: r1rcm.com