Welcome page Returning Candidate? Log back in! CLAIMS ESCALATION SPECIALIST Job Locations US-CO-ENGLEWOOD ID 2024-151796 Line of Business Amerita Position Type Full-Time Pay Min USD $24.00/Hr. Pay Max USD $26.00/Hr. Our Company

Amerita

Overview

Reporting to the Reimbursement Compliance Project Manager of the RCM Team, the Claims Escalation Specialist/Team oversees stakeholder and executive relationships by providing responses to escalated payer issues identified by our Regulators, RCM Specialist and Executives. The Specialist will ensure the department maximizes tracking, performance, and responses associated with claim escalations and payer issues to lower the risk for customer dissatisfaction and overall AR impact. The Specialist will aid in proactive communications to key stakeholders internally and externally. This role is expected to provide organized tracking expertise as well as build internal and external relationships to deliver on process and performance improvements.

 

• Medical, Dental & Vision Benefits plus, HSA & FSA Savings Accounts
• Supplemental Coverage – Accident, Critical Illness and Hospital Indemnity Insurance
• 401(k) Retirement Plan with Employer Match
• Company paid Life and AD&D Insurance, Short-Term and Long-Term Disability
• Employee Discounts
• Tuition Reimbursement
• Paid Time Off & Holidays 

Responsibilities Creates, manages, and maintains project escalation reporting to both internal /external stakeholders and regulatory agenciesDelivers user-friendly reimbursement solutions that will drive accuracy and standardization Maintains a process of proactive communication to customers external and internal stakeholders on receipt of project escalation, expected response time, and final resolution as required Provides analysis on root cause issues, support initiatives and process improvements Assists in creating and building Standard Operating Procedures/ Amerita Best Practices and training plan(s) to ensure sustainability and control complianceSupports and attends regulatory discussions as requiredDevelops and maintains relationships with internal/external stakeholders and regulatory external stakeholders Investigates, analyzes, resolves, and responds to escalated complaints filed by internal and external customers, Stakeholders, Executives, state and local government officials, commissions, regulators, elected officials, Media, Small Claims and Better Business BureauPromotes and implements procedural best practice through structured quality assurance across all the team(s) to ensure all working practices are compliant with medical policies and regulatory requirementsEmergency and storm role commitment; this is a special assignment that comes into play during storms and other emergencies when the company needs to restore power or respond to other issues affecting customer service  Qualifications

 

Associates Degree in Accounting, Business, or Finance is a plusHome infusion experience is a plusExposure to CMS/Industry Standard regulatory requirementsThree years of experience, or an equivalent combination of education and experience on a year-for-year basis, is required.A demonstrated ability to guide and manage cross-functional and team projects, absorb information, develop creative/practical solutions, and achieve desired results in an operational environment is required. Excellent analytical, organizational, and time management skills with the ability to manage a diverse range of projects simultaneously Consistency in delivering on commitments, ownership of the results, exhibiting high standards of integrity while engaging, empowering, and driving accountability to effectively deliver results.Knowledge and understanding of Medicare, Medicaid, and Commercial policies, processes, systems, pricelists, general practices and how to apply them effectivelyKnowledge and understanding of customer systems within a regulated environment  About our Line of Business Amerita is a specialty infusion company focused on providing complex pharmaceutical products and clinical services to patients outside of the hospital. Committed to excellent service, our vision is to combine the administrative efficiencies of a large organization with the flexibility, responsiveness and entrepreneurial spirit of a local provider. For more information about Amerita, please visit www.ameritaiv.com. Follow us on Twitter and LinkedIn. Additional Job Information

The company reserves the right to determine if this position will be assigned to work on-site, remotely, or a combination of both. Assigned work location may change. In the case of remote work, physical presence in the office/on-site may be required to engage in face-to-face interaction and coordination of work among direct reports and co-workers.

Salary Range USD $24.00 - $26.00 / Hour