No Pay No Response Specialist

Overview

Ventra Health is a prominent provider of business solutions catering to facility-based physicians in specialties like anesthesia, emergency medicine, hospital medicine, pathology, and radiology. The company specializes in Revenue Cycle Management by partnering with healthcare providers such as private practices, hospitals, health systems, and ambulatory surgery centers. They offer transparent, data-driven services that address complex revenue and reimbursement challenges to allow clinicians to concentrate on quality patient care.

Role Summary

The No Pay No Response Specialist is charged with evaluating collections, addressing unpaid claims, and managing complex billing inquiries. They ensure follow-up with insurance payers for claims payment compliant with client agreements and adhere to all legal billing requirements.

Key Responsibilities

• Address claim denials and rejections by conducting follow-ups to maximize appropriate reimbursement for clients.
• Timely processing of accounts receivable assignments provided by management.
• Prepare and submit appeals based on established protocols aiming for rapid resolution.
• Identify and rectify denied, unpaid, or unresolved claims due to factors like coverage, documentation requests, or pre-authorizations.
• Provide recommendations for account write-offs through adjustment requests.
• Report any changes in addresses or filing rules to supervisors.
• Monitor systems to detect missing payments and update patient accounts accurately.
• Review correspondence thoroughly to identify specific issues and conduct account research as needed.
• Determine appropriate follow-up measures including adjustments, correspondence, and insurance communications.
• Manage the appeal processes and organize related documentation appropriately.
• Engage in inbound and outbound calls to ensure claims follow-up and inquiry handling.
• Communicate clearly with insurance companies regarding claim status.
• Achieve defined production and quality targets established by the company.
• Take on special projects and assigned duties as required.

Required Qualifications and Experience

• High school diploma or GED equivalent.
• Minimum of one year experience in data entry and medical billing/claims resolution preferred.
• Certifications from AAHAM or HFMA are advantageous.
• Experience collaborating with offshore teams desirable.

Skills and Competencies

• Intermediate knowledge of medical billing practices including coordination of benefits, modifiers, Medicare/Medicaid, and explanation of benefits (EOB) comprehension.
• Proficiency in using billing software within five weeks and maintaining expertise.
• Capability to interpret and implement state and federal billing laws and regulations.
• Strong interpersonal skills to communicate professionally across diverse groups.
• Flexibility and ability to thrive in a collaborative, fast-paced environment.
• Basic technological proficiency including computer, telephone, internet, copier, fax, and scanner use.
• Competence in 10-key data entry and fundamental math skills.
• Adherence to company policies and procedures.
• Effective oral, written communication and time management abilities.
• Working knowledge of Microsoft Outlook, Word, Excel (including pivot tables), and database software.

Compensation and Incentives

Base salary is determined by factors such as candidate location, expertise, professional background, and qualifications. The role also qualifies for a discretionary performance-based incentive bonus under company policy.

Additional Information

Ventra Health operates as an equal opportunity employer fostering a diverse and inclusive work culture. Applications are welcomed from all qualified individuals regardless of race, gender, age, disability, or other protected statuses. Reasonable accommodations are provided for qualified candidates with disabilities.

The company does not collaborate with recruitment agencies and does not charge applicants any fees. Warnings against fraudulent recruitment attempts are issued, encouraging candidates to verify communications through official channels. Ventra Health is committed to accessible digital experiences and continuously improves its platforms to meet accessibility standards.