by twochickswithasidehustle | Jun 6, 2025 | Uncategorized
Thank you for considering a career at Ensemble Health Partners!
Ensemble Health Partners 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
The Opportunity:
CAREER OPPORTUNITY OFFERING:
- Bonus Incentives
- Paid Certifications
- Tuition Reimbursement
- Comprehensive Benefits
- Career Advancement
- This position pays between $28.90 – $35.45/hr based on experience
- $$ Shift Differential for Select Shifts $$
**Must have Current unrestricted LPN or RN license (required) or RN compact license (preferred)**
We are seeking part time Virtual Utilization Review Specialists who are interested in compressed, weekend work schedules. The schedules we are offering include:
Work Schedule:
- Saturday & Sunday, 1st shift, working two 10-hr shifts
- Saturday & Sunday, 1st shift, working two 8-hr shifts + a 4-hr shift on Monday
Resource Utilization
- Utilizes proactive triggers (diagnoses, cost criteria, and complications) to identify potential over/under utilization of services
- Initiates appropriate referral to physician advisor in a timely manner
- Understands proper utilization of health care resources and assists with identifying barriers to patient progress and collaborates with the interdisciplinary team
- Collaborates with financial clearance center, patient access, financial counselors and/or business office regarding billing issues related to third party payers
Medical Necessity Determination
- Conducts medical necessity review of all admissions. Utilizes approved clinical review criteria to determine medical necessity for admissions including appropriate patient status and continued stay reviews, possibly from an offsite location
- Provides inpatient and observation (if indicated) clinical reviews for commercial carriers to the Financial Clearance Center (FCC) within one business day of admission
- Communicates all medical necessity review outcomes to in-house care management staff and relevant parties as needed
- Collaborates with the in-house staff and/or physician to clarify information, obtain needed documentation, present opportunities and educate regarding appropriate level of care
- Collaborates with the financial clearance center, patient access, financial counselors, and/or business office regarding billing issues related to third party payers
Denial Management
- Coordinates the P2P process with the physician or physician advisor, FCC, Revenue Cycle team when necessary and when assigned and maintains documentation relevant to the appeal process
- Maintains appropriate information on file to minimize denial rate
- Assist in recording denial updates; overturned days and monitor and report denial trends that are noted
- Monitor for readmissions
Quality/Revenue Integrity
- Demonstrates active collaboration with other members of the health care team to achieve the outcomes management goals including CMS indicators
- Accurately records data for statistical entry and submits information within required time frame
- Responsible for ConnectCare and ADT work queues assigned to VUR for revenue cycle workflow
- Accurately records data for statistical entry and submits information within required time frame
- Documentation will reflect all work and communication related to the FCC, payor, physician, physician advisor and in-house care management
- Second-level physician reviews will be sent as required and responses/actions reflected in documentation
Facilitation of Patient Care
- Prioritizes patient reviews based on situational analysis, functional assessment, medical record review, and application of clinical review criteria
- Collaborates with the in-house care manager Maintains rapport and communication with the in-house care manager Demonstrates the knowledge and skills necessary to provide care appropriate to the age of the patients served on his or her assignment
- Demonstrates knowledge of the principles of growth and development of the life span and possesses the ability to assess data reflective of the patient’s status and interprets the appropriate information needed to identify each patient’s requirements relative to his or her age, specific needs and to provide the care needed as described in departmental policies and procedures
Communication
- Directs physician and patient communication regarding non-coverage of benefits
- Maintains positive, open communication with the physicians, nurses, multidisciplinary team members and administration
- Educates hospital and medical staff regarding utilization review program
- Maintains a calm, rational, professional demeanor when dealing with others, even in situations involving conflict or crisis
- Voicemail, Skype, and email will be utilized and answered in timely fashion
- Hospital provided communication devices will be used during work hours
- Staff is expected to respond and/or acknowledge communication from the FCC via approved communication guidelines and standardized service-line agreements
- Staff must be available as designated for meetings or training, onsite or online, unless prior arrangements are made
Team Affirmation
- Works collaboratively with peers to achieve departmental goals in daily work as evidenced by appropriate and timely communication which is respectful and clear. Sensitive to workload of peers and shares responsibilities, fills in and offers to help
- Actively participates in departmental process improvement team; planning, implementation, and evaluation of activities
- Provides back-up support to other departmental staff as needed
Other Job Functions
- Complies with FCC and department policies and procedure, including confidentiality and patient’s rights
- Maintains clinical competency and current knowledge of regulatory and payer requirements to perform job responsibilities (i.e., medical necessity criteria, MS-DRGs, POA)
- Actively participates in departmental meetings and activities
- Participates in FCC and community committees as assigned
- Actively participates in conferences, committees, and task forces as directed by the FCC division
- Associates may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation
Experience:
- Bachelor’s Degree or equivalent experience; Specialty/Major: Nursing or related field
- Current unrestricted LPN or RN license required; RN compact license preferred
- Five years nursing experience in an acute care environment required
- Utilization review/discharge planning experience preferred
- Recent experience or working knowledge of medical necessity review criteria preferred
- Current working knowledge of quality improvement processes
Other Knowledge, Skills, and Abilities Required:
- Ability to work a compressed weekend schedule
- This is a remote role which requires access to high speed internet
- Excellent interpersonal, communication and negotiation skills in interactions with physicians, payors, and health care team colleagues
- Commitment to exceptional customer service at all times
- Communicate ideas and thoughts effectively verbally and in writing
- Strong clinical assessment, organization and problem-solving skills
- Ability to assess and identify appropriate resources, internal and community, on assigned caseload, and to work collaboratively with health care team, providers, and payors to achieve the desired patient, quality, and financial outcomes
- Ability to prioritize, organize information, and complete multiple tasks effectively in a fast-paced environment
- Resourceful and able to work independently
#LI–SI1
#LI-REMOTE
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
- Innovation
- Work-Life Flexibility
- Leadership
- Purpose + Values
Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include:
- Associate Benefits – We offer a 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.
- Our Culture – Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation.
- Growth – We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.
- Recognition – We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.
Ensemble Health Partners is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws. Ensemble Health Partners also prohibits harassment of applicants or employees based on any of these protected categories.
Ensemble Health Partners provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require accommodation in the application process, please contact [email protected].
This posting addresses state specific requirements to provide pay transparency. Compensation decisions consider many job-related factors, including but not limited to geographic location; knowledge; skills; relevant experience; education; licensure; internal equity; time in position. A candidate entry rate of pay does not typically fall at the minimum or maximum of the role’s range.
by twochickswithasidehustle | Jun 6, 2025 | Uncategorized
Here at Savista, we enable our clients to navigate the biggest challenges in healthcare: quality clinical care with positive patient experiences and optimal financial results. We partner with healthcare organizations to problem solve and deliver revenue cycle improvement services that enable their success, support their patients, and nurture their communities, all while living our values of Commitment, Authenticity, Respect and Excellence (CARE).
Job Purpose
The Financial Clearance Specialist role ensures seamless and accurate processing of financial clearance procedures. Responsibilities include contacting insurance companies, physicians, and patients to ensure patient demographic and insurance information is collected, and that a financial clearance determination can be made. It will also inform patients of their rights, financial policies, and collects patient liabilities.
Duties & Responsibilities
- Process and verify administrative and financial components of financial clearance including validation of insurance benefits, medical necessity, routine and complex pre-certification, prior-authorization, scheduling and pre-registration, patient benefit and cost estimates, and pre-collection of out-of-pocket cost share.
- Obtain pre-certifications, authorizations, and referrals for upcoming appointments.
- Communicate recommended changes to schedules and care planning to ensure alignment with authorization requests and payor compliance
- Liaison between patient, insurance payors and providers to obtain prior authorization for prescheduled services
- Effectively address issues and offer information and support to both patients and physicians concerning financial clearance matters
- Process stat request prioritization
- Verify demographic information
- Apply payor changes to registration
- Verify, edit and/or remove user defined referral counts editing final status of referrals
- Edit the scheduled date within the referral, pend referrals to any pools, suppressing expiring referrals messages, accessing assigned referral work queues, defer/activate referral work queue items, use referral templates
- Apply critical thinking skills to identify and resolve problems proactively
Qualifications & Competencies
- High School Diploma or equivalent
- 3+ years’ experience with patient registration in a hospital or physician office, directly with obtaining patient demographic and financial information, handling insurance verification and obtaining authorizations
- Proficient with commercial and government insurance plans, payer networks, government resources
- Proficient with medical and insurance terminology
- Strong customer service skills, including ability to understand, interpret, evaluate, and resolve basic to complex service issues.
- Strong attention to detail and accuracy
- Excellent verbal and written communication, telephone etiquette, interviewing, and interpersonal skills to interact with peers, management, patients, client, and external agencies
- Ability to work with a variety of stakeholders
- Proficient in utilizing a variety of computer applications and software, including but not limited to Microsoft Office Suite, Internet Explorer, and other relevant programs
- Proven track record in roles that involve managing multiple critical priorities, with a focus on delivering high-quality results and meeting performance metrics
Note: Savista is required by state specific laws to include the salary range for this role when hiring a resident in applicable locations. The salary range for this role is from $20.00 to $22.00 However, specific compensation for the role will vary within the above range based on many factors including but not limited to geographic location, candidate experience, applicable certifications, and skills.
SAVISTA is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, age, veteran status, disability, national origin, sex, sexual orientation, religion, gender identity or any other federal, state or local protected class.
by twochickswithasidehustle | Jun 6, 2025 | Uncategorized
Here at Savista, we enable our clients to navigate the biggest challenges in healthcare: quality clinical care with positive patient experiences and optimal financial results. We partner with healthcare organizations to problem solve and deliver revenue cycle improvement services that enable their success, support their patients, and nurture their communities, all while living our values of Commitment, Authenticity, Respect and Excellence (CARE).
Savista partners with healthcare providers to improve their financial strength by implementing integrated spend management and revenue cycle solutions that help control cost, improve margins and cash flow, increase regulatory compliance, and optimize operational efficiency.
The Medical Insurance Accounts Receivable Representative is responsible for ensuring the timely collection of outstanding government or commercial healthcare insurance receivables.
Essential Duties & Responsibilities
- Verify/obtain eligibility and/or authorization utilizing payer web sites, client eligibility systems or via phone with the insurance carrier/providers
- Update patient demographics/insurance information in appropriate systems –
- Research/ Status unpaid or denied claims
- Monitor claims for missing information, authorization and control numbers(ICN//DCN)
- Research EOBs for payments or adjustments to resolve claim
- Contacts payers via phone or written correspondence to secure payment of claims; reconsideration and appeal submission.
- Access client systems for payment, patient, claim and data info
- Follows guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systems
- Secure needed medical documentation required or requested by third party insurance carriers
- Maintain and respect the confidentiality of patient information in accordance with insurance collection guidelines and corporate policy and procedure
- Perform other related duties as required
Minimum Requirements & Competencies
- 2-3 years of medical collections, denials and appeals experience
- Experience with all but not limited to the following denials- DRG downgrades, level of care, coding, medical necessity
- Intermediate knowledge of ICD-10, CPT, HCPCS and NCCI
- Intermediate knowledge of third party billing guidelines
- Intermediate knowledge of billing claim forms(UB04/1500)
- Intermediate knowledge of payor contracts- commercial and government
- Intermediate Working Knowledge of Microsoft Word and Excel
- Intermediate knowledge of health information systems (i.e. EMR, Claim Scrubbers, Patient Accounting Systems, etc.)
Preferred Requirements & Competencies
- Intermediate knowledge of one or more of the following Patient accounting systems – EPIC, Cerner, STAR, Meditech, CPSI, Invision, PBAR, All Scripts or Paragon
- Intermediate of DDE Medicare claim system
- Intermediate Knowledge of government rules and regulations
Savista is required by state specific laws to include the salary range for this role when hiring a resident in applicable locations. The salary range for this role is from $18.00 to $22.00. However, specific compensation for the role will vary within the above range based on many factors including but not limited to geographic location, candidate experience, applicable certifications, and skills.
SAVISTA is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, age, veteran status, disability, national origin, sex, sexual orientation, religion, gender identity or any other federal, state or local protected class.
by twochickswithasidehustle | Jun 6, 2025 | Uncategorized
Here at Savista, we enable our clients to navigate the biggest challenges in healthcare: quality clinical care with positive patient experiences and optimal financial results. We partner with healthcare organizations to problem solve and deliver revenue cycle improvement services that enable their success, support their patients, and nurture their communities, all while living our values of Commitment, Authenticity, Respect and Excellence (CARE).
Company Overview:
Savista partners with healthcare providers to improve their financial strength by implementing integrated revenue cycle solutions that help control cost, improve margins and cash flow, increase regulatory compliance, and optimize operational efficiency.
Job Purpose:
The Coder II reviews clinical documentation to code diagnoses and surgical CPT procedures for hospital-based claims and data needs. For either professional or technical claims and data needs, the Coder II reviews clinical documentation to code diagnoses, EM level, and surgical CPT procedures. Additionally, this role also validates APC calculations, abstracts clinical data, mitigates diagnosis, EM level, and/or surgical CPT coding-related claims scrubber edits, and may interact with client staff and providers.
Essential Duties & Responsibilities:
· Assigns ICD-10-CM codes, either professional or technical EM level, and surgical CPT codes at commercially reasonable production rates and at a consistent 95% or greater quality level.
· Validates APC assignments, as applicable.
· Abstracts clinical data appropriately.
· Mitigates diagnosis, EM level, and/or surgical CPT coding-related claims scrubber edits.
· Participates in client and Savista meetings and training sessions as instructed by management.
· Maintains an ongoing current working knowledge of the coding convention in play at client assignments.
· Performs other related duties as required.
Minimum Qualifications:
· An active AHIMA (American Health Information Association) credential or an active AAPC (American Academy of Professional Coders) credential
· One year of relevant coding experience for the specific patient type being hired and within the last six months
· Passing score of 80% on specific pre-employment tests assigned
Note: Savista is required by state specific laws to include the salary range for this role when hiring a resident in applicable locations. The salary range for this role is from $28.00 – $33.00 an hour. However, specific compensation for the role will vary within the above range based on many factors including but not limited to geographic location, candidate experience, applicable certifications, and skills.
SAVISTA is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, age, veteran status, disability, national origin, sex, sexual orientation, religion, gender identity or any other federal, state or local protected class.
by twochickswithasidehustle | Jun 6, 2025 | Uncategorized
Here at Savista, we enable our clients to navigate the biggest challenges in healthcare: quality clinical care with positive patient experiences and optimal financial results. We partner with healthcare organizations to problem solve and deliver revenue cycle improvement services that enable their success, support their patients, and nurture their communities, all while living our values of Commitment, Authenticity, Respect and Excellence (CARE).
Essential Duties & Responsibilities:
- Utilize various hospital/physician systems to verify patient, billing and claim information for accuracy
- Perform compliant primary/secondary, tertiary and rebill billing functions which can include electronic, paper and portal submission to payers.
- Edit claims to meet and satisfy billing compliance guidelines for electronic and hardcopy submission.
- Respond timely to emails and telephone messages as appropriate.
- Communicate issues to management, including payer, system or escalated account issues.
- Participate and attend meetings as requested, training seminars and in-services to develop job knowledge.
- Serves and protects the hospital community by adhering to professional standards, hospital policies and procedures, federal, state, and local requirements, and JCAHO standards.
- Enhances billing department and hospital reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.
- Update patient demographics/insurance information in appropriate systems –
- Monitor claims for missing information, authorization and control numbers(ICN//DCN)
- Follows guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systems
- Secure needed medical documentation required or requested by third party insurance carriers
- Maintain and respect the confidentiality of patient information in accordance with insurance collection guidelines and corporate policy and procedure
- Perform other related duties as required
Minimum Requirements & Competencies:
- High School Diploma or GED
- At least one year of experience in healthcare insurance billing, working with or for a hospital/hospital system, working directly with government or commercial payers.
- Experience identifying billing errors and resubmitting claims as well as following up on payment errors, low reimbursement and denials.
- Experiences reading and utilizing EOB, 1500 and UB-O4 Forms
- Knowledge of CD-10, CPT, HCPCS and NCC
- Knowledge and ability to utilize third-party billing guidelines
- A minimum of 6 months experience of billing claim forms (UB04/1500)
- Understanding payor contracts and the ability to read and interpret them.
- Basic working knowledge of health information systems (i.e. EMR, Claim Scrubbers, Patient Accounting Systems, etc.)
- Knowledge of accounts receivable practices, medical business office procedures, coordination of benefit rules and denial overturns and third-party payer billing and reimbursement procedures and practices.
- Demonstrated ability to navigate Internet Explorer and Microsoft Office, including the ability to input and sort data in Microsoft Excel and use company email and calendar tools.
- Demonstrated success working both individually and in a team environment.
- Demonstrated experience communicating effectively with payers, understanding complex information and accurately documenting the encounter.
- Demonstrated ability to meet performance objectives.
Preferred Requirements & Competencies:
- Working knowledge of one or more of the following Patient accounting systems – EPIC, Cerner, STAR, Meditech, CPSI, Invision, PBAR, All Scripts or Paragon
- Working knowledge of DDE Medicare claim system
- Knowledge of government rules and regulations.1
Note: Savista is required by state specific laws to include the salary range for this role when hiring a resident in applicable locations. The salary range for this role is from $17.00 to $19.50. However, specific compensation for the role will vary within the above range based on many factors including but not limited to geographic location, candidate experience, applicable certifications, and skills.
SAVISTA is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, age, veteran status, disability, national origin, sex, sexual orientation, religion, gender identity or any other federal, state or local protected class.
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