Claims Escalation Specialist / Remote

Amerita

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.

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

• 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

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.