Ensemble Health Partners · 13 hours ago
Sr Specialist, Transfer Diagnosis Related Group
United States
Full-time
Remote
Entry Level
$22.45/hr - $24.70/hr
1+ years expEnsemble Health Partners is a leading provider of technology-enabled revenue cycle management solutions for health systems. The role involves identifying potential underpayment opportunities for transfer DRGs and ensuring compliance with Medicare policies while maintaining strong relationships with clients and team members.
Health CareHospitality
Responsibilities
Work from inventory reports assigned by leadership to identify potential transfer DRG underpayment opportunities
Using the validation process, ensure identified underpayments are pursuable utilizing resources including online Medicare administrative contractor (MAC) portals, DDE, CMS inpatient prices, Ensemble proprietary software, and client host systems
Understand the Medicare PACT policy, the affected discharge dispositions, and post-acute service providers
Identify and determine facility information for follow up and calls to MACs and post-acute care providers, including home health agencies, skilled nursing facilities, assisting living facilities and long-term care facilities
Review patient medical records to determine if post-acute care was received and contacting the post-acute providers to determine dates of service and level of care provided
Develop and maintain strong working relations with the assigned client and team members
Respond to organizational and client needs appropriately and timely
Qualification
Required
1 - 2 years of experience working with hospital insurance claims and a working knowledge of the hospital revenue cycle
Associate degree or equivalent work experience required
Preferred
Bachelor's degree preferred
Basic knowledge of Medicare and managed Medicare concepts, including plan reimbursement
Basic skills in Microsoft Office, including Excel, Word, and Teams
Strong, clear, and effective communication, organization, and prioritization skills
Effective and proven analytical skills that provide the foundation to identify potential underpayments
Benefits
Bonus Incentives
Paid Certifications
Tuition Reimbursement
Comprehensive Benefits
Career Advancement
Associate Benefits – 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.
Growth – We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.
Recognition – We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.
Company
Ensemble Health Partners
Ensemble Health Partners is the leading revenue cycle management company for hospitals, health systems and physician practices.
10001+ employees
Funding
Current Stage
Late StageTotal Funding
unknown2022-03-25Private Equity
2019-05-30Acquired
Leadership Team
Judson Ivy
Founder and CEO
Matt Tormey
EVP Compliance and Risk
Recent News
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