Sr Specialist, Transfer Diagnosis Related Group

Reposted 13 Hours Ago
Be an Early Applicant
Hiring Remotely in United States
Remote
22-25 Hourly
Junior
Healthtech • Financial Services
The Role
The role involves identifying underpayment opportunities in hospital insurance claims, validating these claims, and liaising with post-acute care providers and MACs, utilizing various Medicare resources and Ensemble software.
Summary Generated by Built In

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:

CAREER OPPORTUNITY OFFERING:

  • 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.

Job Experience

  • 1 - 2 years

Other Preferred Knowledge, Skills and Abilities:

  • Minimum of 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.

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 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 also prohibits harassment of applicants or employees based on any of these protected categories.

Ensemble 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.

Employment Disclaimers – Ensemble

Skills Required

  • Minimum of 1 - 2 years of experience working with hospital insurance claims
  • Working knowledge of the hospital revenue cycle
  • Associate degree or equivalent work experience
  • Basic knowledge of Medicare and managed Medicare concepts
  • Basic skills in Microsoft Office including Excel, Word, and Teams

Ensemble Health Partners Compensation & Benefits Highlights

The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Ensemble Health Partners and has not been reviewed or approved by Ensemble Health Partners.

  • Strong & Reliable Incentives Quarterly bonuses, shift differentials, and performance-tied incentives are portrayed as meaningful additions to base pay. An all-employee bonus program and pay-for-performance approach are consistently highlighted.
  • Leave & Time Off Breadth Paid time off and holidays form a solid baseline for time away. Some accounts describe these as helpful to work-life balance and overall job value.
  • Career-Linked Recognition & Rewards Yearly raises, recognition of strong performance, and structured advancement ladders are called out in places. Paid certifications and tuition reimbursement reinforce development-linked rewards.

Ensemble Health Partners Insights

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The Company
HQ: Cincinnati, OH
3,463 Employees
Year Founded: 2014

What We Do

Ensemble Health Partners is a leading innovator in revenue cycle management, helping healthcare providers improve financial outcomes and patient experiences with an unrivaled depth of expertise and best-in-class technologies. Ensemble offers full revenue cycle outsourcing as well as a comprehensive suite of healthcare financial management point solutions. With clients spanning the U.S. and Europe, we have been helping to improve healthcare outcomes for millions of patients while saving hundreds of millions of dollars for healthcare providers. We are committed to bringing every provider that we support to the peak of revenue cycle excellence. Our approach forges true partnerships that dive deep into the details to find solutions and deliver results that last. Recognized with multiple industry awards and as a Becker’s Healthcare Top Workplace, Ensemble is setting a new standard for provider support services - redefining the possible in healthcare by empowering people to be the difference.

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