Ensemble Health Partners

Analyst

• Maximize insurance reimbursement by identifying contractual variances between posted payments and expected reimbursement
• Analyze contractual reimbursement and communicate payment discrepancies to internal and external departments
• Identify trends in underpayments and determine effective paths to resolution
• Review remittance data to locate charge or billing opportunities for revenue optimization
• Communicate with payors about outstanding underpayments
• File underpayment appeals with payors and resolve account variances
• Identify root causes of underpayments, denials, and delayed payments
• Collaborate with client teams to document and address accounts-receivable issues
• Apply state and federal insurance regulations and payor-specific requirements
• Document activity in client host systems, Ensemble IQ, or other tracking systems
• Recommend improvements and communicate trends and issues to management
• Compile and analyze data and report findings to leadership
• Meet productivity and quality standards
• Work collaboratively with Managed Care, Billing, Coding, Revenue Integrity, and Payor Strategy departments
• Manage multiple projects, reports, and tasks in a fast-paced, KPI-driven environment

Revenue Recovery Associate Analyst I

Patient Access Specialist

• Perform admitting duties for all patients admitted for hospital services
• Assign accurate medical record numbers (MRNs)
• Complete medical necessity and compliance checks
• Provide patient instructions and excellent customer service
• Collect insurance information and process physician orders
• Operate the telephone switchboard
• Meet assigned point-of-service goals and collect payments, past-due balances, and payment-plan amounts
• Conduct account audits and use quality auditing and reporting systems
• Pre-register patient accounts through inbound and outbound calls
• Explain consent forms and distribute patient education documents
• Review insurance eligibility responses and enter benefit data to support point-of-service collections and clean claims
• Screen medical necessity using ABN software and distribute required forms and pamphlets
• Provide statistical data to Patient Access leadership

Auditor

• Perform outpatient coding audit activities under indirect supervision
• Audit outpatient work types for accurate diagnoses, CPT, HCPCS, CCI edits, and modifier assignment
• Apply ICD-10-CM, CPT, HCPCS, CPT Assistant, Coding Clinic, CMS, and NCCI guidelines
• Participate in client system education to audit accounts against clinical documentation, coding/CDI guidelines, and regulatory standards
• Maintain documentation, spreadsheets, account examples, and claim examples of root-cause issues
• Research governmental, payer-specific, hospital-specific, regulatory, and literature requirements
• Make recommendations to clients regarding coding and billing requirements
• Assist with executive summary reports, education, and client coding companion training
• Meet productivity standards and coding certification requirements
• Attend coding conferences, workshops, and in-house sessions for coding and regulatory updates
• Provide organized, efficient customer service
• Travel to and work onsite at client, temporary, or corporate office locations as business needs require

Outpatient Coding Auditor

• Perform admitting duties for all patients admitted for hospital services
• Assign accurate MRNs
• Complete medical necessity and compliance checks
• Provide patient instructions and collect insurance information
• Receive and process physician orders
• Use an overlay tool and provide excellent customer service
• Operate the telephone switchboard
• Meet assigned point-of-service goals
• Use quality auditing and reporting systems to correct accounts
• Audit accounts and ensure forms are completed accurately and timely
• Pre-register patient accounts before visits
• Obtain demographic, insurance, and patient financial liability information by inbound and outbound calls
• Collect point-of-service collections and past-due balances, including payment plan options
• Explain consent and patient education forms, obtain signatures, and document witnesses
• Review insurance eligibility responses and select applicable plan codes
• Enter benefit data to support point-of-service collections and billing processes
• Screen medical necessity using ABN software and distribute required forms

General

• Research and analyze accounts to identify and recover underpayments
• Determine and complete the appropriate action needed to recover underpayments
• Follow up on underpayments through recovery of outstanding monies
• Communicate directly with payors regarding outstanding underpayments
• File underpayment appeals with payors
• Resolve account variances and ensure timely and accurate recovery
• Identify root causes of underpayments, denials, and delayed payments
• Work with client teams to identify, document, and address accounts receivable issues
• Maintain understanding of applicable state and federal insurance regulations and payor-specific requirements
• Document activity accurately in client host systems, Ensemble IQ, or other tracking systems
• Make recommendations and communicate trends and issues to management
• Resolve underpayments using problem-solving and critical-thinking skills
• Meet productivity and quality standards established by Ensemble and Revenue Recovery leadership
• Develop strong working relationships with client teams and Contract Management counterparts
• Work assigned reports and tasks

Revenue Recovery Specialist II

• Perform admitting duties for all patients admitted for hospital services
• Assign accurate medical record numbers (MRNs)
• Complete medical necessity and compliance checks
• Provide patient instructions and collect insurance information
• Receive and process physician orders
• Utilize an overlay tool and provide excellent customer service
• Operate the telephone switchboard for incoming, outgoing, and inter-office calls
• Meet assigned point-of-service goals
• Use quality auditing and reporting systems to ensure accounts are corrected
• Conduct account audits and provide statistical data to Patient Access leadership
• Pre-register patient accounts before visits
• Make inbound and outbound calls to obtain demographic, insurance, and patient financial information
• Collect point-of-service collections and past-due balances, including payment plan options
• Explain consent and patient education forms, obtain necessary signatures, and witness signatures
• Review insurance eligibility responses and select applicable insurance plan codes
• Enter benefit data to support point-of-service collections and billing processes
• Screen medical necessity using Advanced Beneficiary Notice software
• Distribute and document ABNs and other designated forms and pamphlets

• Perform admitting duties for all patients admitted for hospital services
• Assign accurate medical record numbers (MRNs)
• Complete medical necessity and compliance checks
• Provide patient instructions
• Collect insurance information
• Receive and process physician orders
• Utilize an overlay tool while providing excellent customer service
• Operate the telephone switchboard for incoming, outgoing, and inter-office calls
• Meet assigned point-of-service goals
• Use quality auditing and reporting systems to ensure accounts are corrected
• Conduct account audits and ensure forms are completed accurately and timely
• Provide statistical data to Patient Access leadership
• Pre-register patient accounts before visits
• Make inbound and outbound calls to obtain demographic, insurance, and patient financial liability information
• Collect point-of-service payments and past-due balances, including payment plan options
• Explain general consent forms and obtain signatures and witness names
• Explain and distribute patient education and regulatory forms
• Review insurance eligibility responses and select applicable insurance plan codes
• Enter benefit data to support point-of-service collections and billing processes
• Screen medical necessity using Advanced Beneficiary Notice (ABN) software
• Distribute and document ABNs and other designated forms and pamphlets

• Perform admitting duties for all patients admitted for hospital services
• Assign accurate MRNs and complete medical necessity and compliance checks
• Provide patient instructions and collect insurance information
• Receive and process physician orders
• Operate the telephone switchboard and relay calls
• Meet point-of-service goals and collect patient financial liabilities, past-due balances, and payments
• Conduct quality audits, correct accounts, complete forms accurately and timely, and provide statistical data to Patient Access leadership
• Pre-register patient accounts through inbound and outbound calls
• Explain consent and patient education forms, obtain signatures and witness names, and distribute required documents
• Review insurance eligibility responses, select insurance plan codes, and enter benefit data to support collections and billing
• Screen medical necessity using ABN software and distribute and document designated forms

• Schedule and pre-register patients for appropriate diagnostic procedures based on physician orders
• Select accurate medical records for patient safety
• Provide patient instructions
• Pre-register patients and obtain and validate demographic and insurance information
• Provide excellent customer service
• Perform point-of-service collections and financial counseling functions as appropriate
• Perform other job-related duties as required by the supervisor
• Work within Ensemble policies, processes, mission, and regulatory compliance requirements

Scheduling Specialist

• Interview uninsured and under-insured patients to determine eligibility for state Medicaid benefits or location financial assistance programs
• Assist with application processes to facilitate accurate and appropriate submissions
• Follow up on submitted applications to ensure timely billing or adjustment processing
• Review referred uninsured/under-insured patients for program eligibility opportunities
• Initialize and coordinate application processes
• Communicate with patients to obtain documents required for applications
• Follow submitted applications through determination, update applicable insurance information, and ensure timely billing or adjustment posting
• Document relevant actions and communication steps in assigned patient accounting systems
• Maintain working knowledge of state and federal program requirements and share information with colleagues and supervisors
• Develop and maintain working relationships with county, state, and federal Medicaid caseworker partners
• Collaborate with revenue cycle departments and associates
• Perform other duties as assigned

Public Benefit Specialist

• Perform admitting duties for all patients admitted for hospital services
• Assign accurate MRNs
• Complete medical necessity and compliance checks
• Provide patient instructions and collect insurance information
• Receive and process physician orders
• Utilize an overlay tool while providing excellent customer service
• Operate the telephone switchboard for incoming, outgoing, and inter-office calls
• Meet assigned point-of-service goals
• Use quality auditing and reporting systems to ensure accounts are corrected
• Conduct account audits and provide statistical data to Patient Access leadership
• Pre-register patient accounts before visits
• Make inbound and outbound calls to obtain demographic, insurance, and patient information
• Collect point-of-service payments and past-due balances, including payment plan options
• Explain and obtain signatures for consent and other required forms
• Explain and distribute patient education documents and regulatory forms
• Review insurance eligibility responses and select applicable insurance plan codes
• Enter benefit data to support point-of-service collections and billing processes
• Screen medical necessity using Advanced Beneficiary Notice software
• Distribute and document ABNs and other designated forms and pamphlets

• Perform admitting duties for all patients admitted for hospital services
• Assign accurate MRNs
• Complete medical necessity and compliance checks
• Provide patient instructions and collect insurance information
• Receive and process physician orders
• Utilize overlay tools while providing customer service
• Operate the telephone switchboard and relay incoming, outgoing, and inter-office calls
• Meet assigned point-of-service goals
• Use quality auditing and reporting systems to correct accounts
• Conduct account audits and provide statistical data to Patient Access leadership
• Pre-register patient accounts before visits
• Make inbound and outbound calls to obtain demographic and insurance information
• Collect point-of-service payments and past-due balances, including payment plan options
• Explain consent and patient education forms, obtain signatures, and witness names
• Review insurance eligibility responses and select applicable insurance plan codes
• Enter benefit data to support point-of-service collections and billing processes
• Screen Medicare medical necessity using ABN software and distribute required forms

• Perform admitting duties for all patients admitted for hospital services
• Assign accurate MRNs and complete medical necessity and compliance checks
• Provide patient instructions and collect insurance information
• Receive and process physician orders and utilize an overlay tool
• Operate the telephone switchboard and relay incoming, outgoing, and inter-office calls
• Meet point-of-service collection goals
• Use quality auditing and reporting systems to correct accounts
• Conduct account audits and provide statistical data to Patient Access leadership
• Pre-register patient accounts before visits
• Make inbound and outbound calls to obtain demographic, insurance, and financial liability information
• Collect point-of-service payments and past-due balances and explain payment plan options
• Explain consent forms, obtain necessary signatures, and witness signatures
• Distribute patient education documents and required forms
• Review insurance eligibility responses and enter benefit data to support collections and billing
• Screen medical necessity using ABN software and distribute/document designated forms

Patient Access Associate Specialist

• Interview uninsured and under-insured patients to determine eligibility for state Medicaid benefits or local financial assistance programs
• Assist with application processes to facilitate accurate and appropriate submissions
• Follow up on submitted applications to ensure timely billing or adjustment processing
• Review referred patients for program eligibility opportunities and coordinate application processes
• Communicate with patients to obtain required application documents
• Track applications through determination, update insurance information, and ensure timely billing or adjustment posting
• Document relevant actions and communications in patient accounting systems
• Maintain knowledge of state and federal program requirements and share information with colleagues and supervisors
• Develop working relationships with county, state, and federal Medicaid caseworker partners
• Collaborate with revenue cycle departments and associates
• Perform other duties as assigned

• Interview uninsured/under-insured patients to determine eligibility for state Medicaid benefits or location Financial Assistance programs
• Assist with application processes to facilitate accurate and appropriate submissions
• Follow up on submitted applications to ensure timely billing or adjustment processing
• Review referred uninsured/under-insured patients for program eligibility opportunities and coordinate the application process
• Communicate with patients to obtain required application documents
• Follow submitted applications through determination, update applicable insurance information, and ensure timely billing or adjustment posting
• Document relevant actions and communication steps in assigned patient accounting systems
• Maintain working knowledge of state and federal program requirements and share information with colleagues and supervisors
• Develop and maintain relationships with county/state/federal Medicaid caseworker partners
• Collaborate with revenue cycle departments and associates
• Perform other duties as assigned