Denials Specialist

About Us Ventra is a leading business solutions provider for facility-based physicians practicing anesthesia, emergency medicine, hospital medicine, pathology, and radiology. Focused on Revenue Cycle Management, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions that solve the most complex revenue and reimbursement issues, enabling clinicians to focus on providing outstanding care to their patients and communities. Come Join Our Team! As part of our robust Rewards & Recognition program, this role is eligible for our Ventra performance-based incentive plan, because we believe great work deserves great rewards Help Us Grow Our Dream Team — Join Us, Refer a Friend, and Earn a Referral Bonus! Job Summary The Denials Specialist (Accounts Receivable (“AR”) Specialist) is primarily responsible for analyzing collections, resolving non-payables, and handling bill inquiries for more complex issues. AR Specialists are responsible for insurance payer follow-up ensuring claims are paid according to client contracts. Complies with all applicable laws regarding billing standards. Essential Functions and Tasks Follows up on claim rejections and denials to ensure appropriate reimbursement for our clients. Process assigned AR work lists provided by the manager in a timely manner. Write appeals using established guidelines to resolve claim denials with a goal of one contact resolution. Identified and resolved denied, non-paid, and/or non-adjudicated claims and billing issues due to coverage issues, medical record requests, and authorizations. Recommend accounts to be written off on Adjustment Request. Reports address and/or filing rule changes to the manager. Check the system for missing payments. Properly notates patient accounts. Review each piece of correspondence to determine specific problems. Research patient accounts. Reviews accounts and determines appropriate follow-up actions (adjustments, letters, phone insurance, etc.). Processes and follows up on appeals. Files appeals on claim denials. Inbound/outbound calls may be required for follow-up on accounts. Respond to insurance company claim inquiries. Communicates with insurance companies about the status of outstanding claims. Meet established production and quality standards as set by Ventra Health. Performs special projects and other duties as assigned. Education and Experience Requirements High School Diploma or GED. At least one (1) year in the data entry field and one (1) year in medical billing and claims resolution preferred. AAHAM and/or HFMA certification preferred. Experience with offshore engagement and collaboration desired. Knowledge, Skills, and Abilities Intermediate level knowledge of medical billing rules, such as coordination of benefits, modifiers, Medicare, and Medicaid, and understanding of EOBs. Become proficient in the use of billing software within 4 weeks and maintain proficiency. Ability to read, understand and apply state/federal laws, regulations, and policies. Ability to communicate with diverse personalities in a tactful, mature, and professional manner. Ability to remain flexible and work within a collaborative and fast-paced environment. Basic use of a computer, telephone, internet, copier, fax, and scanner. Basic touch 10 key skills. Basic Math skills. Understand and comply with company policies and procedures. Strong oral, written, and interpersonal communication skills. Strong time management and organizational skills. Strong knowledge of Outlook, Word, Excel (pivot tables), and database software skills. Compensation Base Compensation will be based onvarious factorsunique to eachcandidateincluding geographic location, skill set, experience, qualifications, and other job-related reasons. This position is also eligible fora discretionaryincentivebonusin accordance withcompany policies. Ventra Health Equal Employment Opportunity (Applicable only in the US) Ventra Health is an equal opportunity employer committed to fostering a culturally diverse organization. We strive for inclusiveness and a workplace where mutual respect is paramount. We encourage applications from a diverse pool of candidates, and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, religion, sex, age, national origin, disability, sexual orientation, gender identity and expression, or veteran status. We will provide reasonable accommodations to qualified individuals with disabilities, as needed, to assist them in performing essential job functions. Solicitation of Payment Ventra Health does not solicit payment from our applicants and candidates for consideration or placement. Attention Candidates Please be aware that there have been reports of individuals falsely claiming to represent Ventra Health or one of our affiliated entities Ventra Health Private Limited and Ventra Health Global Services.These scammers may attempt to conduct fake interviews, solicit personal information, and, in some cases, have sent fraudulent offer letters.To protect yourself, verify any communication you receive by contacting us directly through our official channels. If you have any doubts, please contact us at View email address on click.appcast.io to confirm the legitimacy of the offer and the person who contacted you. All legitimate roles are posted on Statement of Accessibility Ventra Health is committed to making our digital experiences accessible to all users, regardless of ability or assistive technology preferences. We continually work to enhance the user experience through ongoing improvements and adherence to accessibility standards. 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