CLAIMS ESCALATION SPECIALIST
BrightSpring Health Services
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 agencies
Delivers 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 compliance
Supports and attends regulatory discussions as required
Develops 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 Bureau
Promotes 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 requirements
Emergency 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 plus
Home infusion experience is a plus
Exposure to CMS/Industry Standard regulatory requirements
Three 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 effectively
Knowledge 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 visitwww.ameritaiv.com. Follow us onTwitter (https://twitter.com/AmeritaIV) and LinkedIn (https://www.linkedin.com/company/amerita-inc/) .
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
ALERT: We are aware of a scam whereby imposters are posing as employees from our company. Beware of anyone requesting financial or personal information. We take pride in creating a best-in-class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card, driver’s license, bank information, or payment for work equipment, etc.) from you via text or email. If you are suspicious of a job posting or job-related email mentioning our company, please contact us at TalentAcquisition@brightspringhealth.com .
Click here (https://www.brightspringhealth.com/careers/frequently-asked-questions/) for additional FAQ information.
Job LocationsUS-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.