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Location: Remote, USAShift: Monday-Friday, Shifts will fall between 8:00AM-6:00PM Central time, 8.5 hour shifts with a 30 minute lunch.R1 RCM Inc. 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 a 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, patients, 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 Team lead will be responsible for investigating and examining denial accounts, will apply appropriate methods and techniques as established internally to resolve applicable issues, identify extenuating circumstances to support technical appeals, knowledgeable in submitting appeals for government and commercial payers, provide 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 Team Lead 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.Responsibilities:
Investigates and examines source of denials utilizing knowledge of charge master, AS4, ICD-10 coding, CPT coding and EDI billing
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
Works closely with third party payers to resolve unpaid claims in proving medical necessity of the patient's admission
Works with HIM and PAS across the enterprise in resolving adverse benefit determinations
Work closely with Appeals staff (Letter writers, Case Managers and Hearing specialists) in obtaining all pertinent information in a timely manner
Performs duties as given by supervisor to fill in where needed: submitting technical appeals, understanding the CAU scope document, helping other teams when required, or any other office function within the CAU
Maintains and follows all HIPAA and confidentiality requirements
Assist in establishing and implementing departmental initiatives
Develop and coach team members in skills and process to promote quality
Measure and monitor staffing levels, assign duties and responsibilities as appropriate
Facilitate team meetings
Troubleshoot and resolve issues with client concerns with a sense of urgency
Fill in production gaps when needed
Other duties as assigned
Required Qualifications:
High School diploma
Minimum of 2 years of experience in follow up, billing or related revenue cycle experience required
Demonstrated extensive knowledge in the health insurance industry (Commercial Insurances, Medicare, Medicaid); health claims billing and/or Third-Party contracts, minimum of two years experience in a specified area
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
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.For this US-based position, the base pay range is $16.16 - $24.79 per hour . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.Learn more about Benefits (http://go.r1rcm.com/benefits) at R1Working 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 including:
Comprehensive Medical, Dental, Vision & RX Coverage
Paid Time Off, Volunteer Time & Holidays
401K with Company Match
Company-Paid Life Insurance, Short-Term Disability & Long-Term Disability
Tuition Reimbursement
Parental Leave
R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.CA PRIVACY NOTICE: California resident job applicants can learn more about their privacy rights California Consent (https://f.hubspotusercontent20.net/hubfs/4941928/California%20Consent%20Notice.pdf)To learn more, visit: R1RCM.comVisit us on Facebook (https://www.facebook.com/R1RCM)R1 RCM is a leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems, and medical groups.Our mission is to make healthcare simpler, so providers and patients can focus on what matters most. R1’s proven and scalable operating models seamlessly 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. Our priority is to always do what is best for our clients, patients, and each other.Headquartered near Salt Lake City, Utah, R1 employs over 27,000 people globally and is traded on the Nasdaq stock exchange under the symbol “RCM.”
