[Hiring] Senior Specialist, Transfer Diagnosis Related Group @Ensemble Health Partners

Role Description

Thank you for considering a career at Ensemble! Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country.

Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference!

O.N.E Purpose:

• Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations.
• Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation.
• Striving for Excellence: Execute at a high level by demonstrating our “Best in KLAS” Ensemble Difference Principles and consistently delivering outstanding results.

The Opportunity:

• Bonus Incentives
• Paid Certifications
• Tuition Reimbursement
• Comprehensive Benefits
• Career Advancement

This position pays between $22.45 - $24.70/hr based on experience.

Essential Job Functions:

• Work from inventory reports assigned by leadership to identify potential transfer DRG underpayment opportunities.
• Using the validation process, ensure identified underpayments are pursuable utilizing resources including online Medicare administrative contractor (MAC) portals, DDE, CMS inpatient prices, Ensemble proprietary software, and client host systems.
• Understand the Medicare PACT policy, the affected discharge dispositions, and post-acute service providers.
• Identify and determine facility information for follow up and calls to MACs and post-acute care providers, including home health agencies, skilled nursing facilities, assisting living facilities and long-term care facilities.
• Review patient medical records to determine if post-acute care was received and contacting the post-acute providers to determine dates of service and level of care provided.
• Develop and maintain strong working relations with the assigned client and team members.
• Respond to organizational and client needs appropriately and timely.

Qualifications

• 1 - 2 years of experience working with hospital insurance claims and a working knowledge of the hospital revenue cycle.
• Associate degree or equivalent work experience required. Bachelor’s degree preferred.
• Basic knowledge of Medicare and managed Medicare concepts, including plan reimbursement.
• Basic skills in Microsoft Office, including Excel, Word, and Teams.
• Strong, clear, and effective communication, organization, and prioritization skills.
• Effective and proven analytical skills that provide the foundation to identify potential underpayments.

Benefits

• Comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.
• Professional development investment, including earning a professional certification relevant to their field and tuition reimbursement.
• Quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.

Company Description

• Join an award-winning company.
• Five-time winner of “Best in KLAS” 2020-2022, 2024-2025.
• Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-2024.
• 22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024.
• Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024.
• Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023.
• Energage Top Workplaces USA 2022-2024.
• Fortune Media Best Workplaces in Healthcare 2024.
• Monster Top Workplace for Remote Work 2024.
• Great Place to Work certified 2023-2024.