Ensemble Health Partners

Patient Access Specialist

• Perform admitting duties for all patients receiving services at the hospital
• Assign accurate MRNs
• Complete medical necessity or compliance checks
• Provide proper patient instructions
• Collect insurance information
• Receive and process physician orders using an overlay tool
• Provide excellent customer service
• Operate the telephone switchboard
• Utilize quality auditing and reporting systems to ensure accounts are corrected
• Develop training materials and programs for new hires
• Provide continuing education to associates in revenue cycle areas
• Develop staff schedules within the patient access department
• Provide on-call, after-hours support and guidance
• Work unscheduled times to cover staffing issues
• Collect point-of-service payments in emergency, outpatient, and inpatient situations
• Conduct account audits and provide statistical data to Patient Access Leadership
• Explain consent and patient education forms, obtain signatures, and distribute required documents
• Review insurance eligibility responses and select applicable insurance plan codes
• Enter benefit data to support point-of-service collections and billing processes
• Pre-register patient accounts and obtain demographic and insurance information
• Screen medical necessity using ABN software and distribute and document designated forms

Senior 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 collect insurance information
• Receive and process physician orders
• Use overlay tools 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 correct accounts
• 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 other patient information
• Collect point-of-service payments and past-due balances, including payment-plan options
• Explain consent forms and obtain required signatures and witness names
• Explain and distribute patient education and regulatory documents
• 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

Associate Specialist, Patient Access

General

• 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 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 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 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 patient financial liability information
• 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 insurance plan codes
• Enter benefit data to support point-of-service collections and billing processes
• Screen medical necessity using ABN software and distribute/document required forms and pamphlets

Patient Access Associate Specialist

Patient Access

• Organize and coordinate assigned staff activities to ensure safe, effective, appropriate, and fiscally responsible work
• Handle and solve problems related to the assigned area
• Coordinate registration and pre-registration duties
• Train, coach, and develop Patient Access staff
• Monitor daily productivity and communicate with staff
• Track and report department performance metrics, including point of service, wait times, overtime, and productivity
• Assign and coordinate staff schedules, rotations, time off, and call-offs
• Track and monitor upfront collection processes; assign goals and provide coaching or corrective action
• Participate in on-call rotation covering days, nights, and weekends as necessary
• Assist with department processes, procedures, audits, staff evaluations, and education
• Act as a resource for staff and ancillary departments and promote excellent customer service
• Manage assigned process implementation and change projects; report to Patient Access Leadership
• Participate in facility activities and meetings
• Maintain the time and attendance system
• Work in designated department areas as needed

Supervisor, Patient Access – Pre-Access

Auditor

• Perform documentation and coding audits for acute inpatient services
• Identify coding errors, compliance issues, educational opportunities, and quality concerns
• Optimize reimbursement by ensuring diagnosis and procedure codes and supporting documentation accurately support services rendered
• Conduct DRG coding and clinical reviews to verify coding, DRG assignment, and clinical indicators
• Assess whether clinical documentation supports coded diagnoses and procedures
• Verify medical records justify assigned DRGs and reflect patient severity and resources used
• Collaborate with CDI specialists on documentation and query opportunities
• Maintain productivity and quality goals set by audit leaders
• Write clear recommendations and provide feedback and education to acute inpatient coders
• Complete audits accurately and timely according to client turnaround and quality expectations
• Maintain current certifications, CEUs, and knowledge of coding guidelines
• Complete internal application, compliance, and mandatory education
• Use proprietary systems and encoder tools to make audit determinations and generate recommendations
• Analyze claims using a 30-day lookback to identify overpayments, underpayments, and discrepancies
• Monitor changes in acute inpatient coding regulations and reimbursement policies
• Identify additional recovery or compliance opportunities and assist with process improvement

DRG Validation Coding Auditor

Coding Specialist

• Review and write appeals for inpatient Diagnosis Related Group (DRG) denials
• Support assigned DRGs and address clinical documentation used to validate assigned codes
• Determine potential billing/coding issues and quality concerns
• Participate in client system education
• Review client accounts to ensure coding is supported by clinical documentation, coding/CDI guidelines, and regulatory standards
• Maintain documentation, spreadsheets, account records, and claim examples of root-cause issues
• Research governmental, payer-specific, hospital-specific, regulatory, and literature rules and guidelines
• Make coding and billing recommendations to clients
• Assist with education and training for client coding companions based on coding appeals outcomes
• Meet established productivity standards and coding certification requirements
• Attend in-house sessions for updated coding and regulatory information
• Provide organized, efficient customer service

Acute Coding Appeals Specialist

Medical Billing and Coding

• Review medical record documentation and accurately assign ICD-9-CM, ICD-10-CM, ICD-10-PCS, CPT IV, and HCPCS codes
• Code outpatient visits including ancillary, urgent care, emergency department, observation, same-day surgery, and interventional procedures
• Utilize 3M software tools, LYNX, coding applications, encoders, CAC, medical necessity software, abstracting systems, code books, and reference materials
• Abstract required data according to facility specifications
• Perform medical necessity checks for Medicare and other payers
• Monitor and work discharged-not-final-billed accounts, failed claims, stop bills, and epremis as part of a team
• Ensure timely and compliant outpatient claims processing
• Maintain productivity, quality, accuracy, and 3M 360 CAC KPI standards
• Stay current on CMS requirements, NCDs, LCDs, modifier guidelines, AHA Coding Clinics, AHIMA ethics, and coding directives
• Report coding software inaccuracies and potential unethical or fraudulent activity
• Attend required meetings and educational sessions and complete annual learning programs

Medical Coding Specialist

• Interview uninsured/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 uninsured/under-insured patients for program eligibility opportunities and coordinate application processes
• Communicate with patients to obtain documents required for applications
• Follow submitted applications through determination, update 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

• 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 applications
• Communicate with patients to obtain required supporting documents
• Track applications through determination, update insurance information, and ensure timely billing or adjustment posting
• Document actions and communications in patient accounting systems
• Maintain knowledge of state and federal program requirements and share information with colleagues and supervisors
• Build relationships with county, state, and federal Medicaid caseworker partners
• Collaborate with revenue cycle departments and associates
• Perform other duties as assigned

Associate

• Review and apply payments from insurance carriers, patients, and third-party payers to appropriate accounts
• Research and resolve unapplied or misapplied cash
• Identify and correct posting errors
• Communicate with internal teams to address payment issues
• Maintain detailed records and adhere to compliance standards
• Contribute to process improvements that enhance revenue-cycle efficiency and accuracy
• Perform other job-related duties as required by the supervisor

Cash Application Associate Specialist

Analyst

• Perform in-depth analysis of claims, payments, and account reconciliations
• Ensure accuracy and compliance across the revenue cycle
• Identify trends in underpayments, denials, and revenue leakage
• Evaluate root causes and recommend corrective actions
• Review and validate claim and payment data
• Interpret contract reimbursement terms
• Prepare detailed reports
• Work assigned underpayment projects
• Collaborate with cross-functional teams
• Escalate complex issues
• Support continuous improvement initiatives to optimize processes and reduce cycle times
• Provide revenue cycle operations reporting and analysis
• Escalate issues and concerns to leadership
• Analyze historical data and staffing to forecast future requirements
• Support the review, recommendation, and implementation of metrics and reporting
• Assist in strategic planning and ongoing process improvement evaluation
• Provide exceptional service to internal and external stakeholders

Revenue Cycle Analyst

• Organize and coordinate assigned staff activities to ensure safe, effective, appropriate, and fiscally responsible work
• Handle and solve problems related to the assigned area
• Maintain working knowledge of area functions
• Partner with the Patient Access Manager to develop and coach staff
• Conduct and oversee orientation and training of Patient Access staff
• Perform Revenue Cycle tasks to ensure compliance and excellent customer service
• Assist the Patient Access Manager with day-to-day operations
• Coordinate registration and pre-registration duties and monitor daily productivity
• Provide and review performance reporting on point of service, wait times, overtime, productivity, and other metrics
• Assign and coordinate staff schedules, rotations, time off, and call-offs
• Track and monitor upfront collection processes, assign goals, and provide coaching or corrective action
• Provide administrative and educational guidance during on-call duties and fill in for staffing issues or unexpected volumes when necessary
• Develop department processes and procedures; conduct training, education, development, and audits
• Serve as a resource for staff and ancillary departments and promote service excellence
• Manage assigned projects involving implementation, tracking, and process changes; report to Patient Access Leadership
• Participate in facility activities, gather statistical information, and work in designated department areas as needed
• Assist with staff evaluations and maintain the time/attendance system
• Attend facility meetings as required to ensure process alignment and effective communication

Patient Access Supervisor

• 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
• Operate the telephone switchboard
• Provide compassionate customer service
• 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
• Obtain demographic, insurance, and financial liability information through inbound and outbound calls
• Collect point-of-service collections and past-due balances, including payment plan options
• Explain consent and patient education forms and obtain required signatures
• Review insurance eligibility and select applicable insurance plan codes
• Enter benefit data to support point-of-service collections and billing processes
• Screen medical necessity using ABN software and distribute required forms

Product Manager

• Lead the continued expansion of assigned Ensemble IQ workflow products within the back end of revenue cycle
• Engage with cross-functional matrix partners to define business requirements based on valued outcomes
• Document product definitions, including roadmaps, scope, feature definitions, business models, and workflows
• Engage directly with delivery teams to ensure a holistic, value-focused approach in an Agile framework
• Collaborate with revenue cycle operations and apply market research to develop requirements supporting product strategy and roadmaps
• Gather and document user requirements and develop business cases covering revenue yield and productivity cost savings
• Contribute to funding and approval requests for the IT steering committee
• Collaborate with engineering to deliver prioritized features in Agile and DevOps frameworks
• Create, maintain, and communicate prioritized product and team backlogs
• Contribute to marketing collateral and product demonstrations
• Coordinate deliverables with global teams

Senior Patient Access Specialist

Associate Specialist, Patient Access

Public Benefit Specialist

Patient Access Associate Specialist

Supervisor, Patient Access – Pre-Access

DRG Validation Coding Auditor

Acute Coding Appeals Specialist

Medical Coding Specialist

Public Benefit Specialist

Public Benefit Specialist

Cash Application Associate Specialist

Revenue Cycle Analyst

Patient Access Supervisor

Patient Access Associate Specialist

Senior Product Manager