R1 is a leading provider of technology-enabled revenue cycle management services which transform and solve challenges across health systems, hospitals and physician practices. Headquartered in Chicago, R1 is publicly-traded organization with employees throughout the US and international locations.

Our mission is to be the one trusted partner to manage revenue, so providers and patients can focus on what matters most. Our priority is to always do what is best for our clients, patient’s and each other. With our proven and scalable operating model, we complement a healthcare organization’s infrastructure, quickly driving sustainable improvements to net patient revenue and cash flows while reducing operating costs and enhancing the patient experience.

The Senior Reimbursement Analyst is responsible for the appropriate management of assigned accounts. Responsibilities include initial reviews, calling insurance companies to resolve authorization and claim denials, writing appeals and letters to insurance companies to resolve denials, and following up on appeals to the point of exhaustion or payment.

Essential Duties and Responsibilities

• This is not an inclusive list. Other duties may be assigned

• Resolve, call and/or appeal a defined number of accounts as instructed by the Partners and/or management.

• Draft complex and contractual appeals and letters to insurance companies.

• Review and apply client contract language and rates as necessary to resolve denied claims.

• Maintain an understanding of and apply per diem, case rate and DRG payment methodologies as needed.

• Utilize payer provider and administrative manuals to dispute denied claims.

• Make proper notations in Quantum on all accounts.

• Use proper approved note structure when notating all accounts.

  • Insurance company name @ number dialed | First name and last initial of the representative spoken to. (Ex. Aetna @ 1-800-624-0756 | John S.)

• Follow up on all appeals, claims, letters or other documentation within 20 days of the submission.

• Follow up on all payments at the time an overturn letter is received.

• Demonstrate an understanding of office workflow by completing the Medtrak tab, Denials tab and Notes tab correctly.

• Ensure that assigned accounts are appealed timely through the use of Quantum Appeals worklist.

• Maintain worklist through daily audits and the open task report.

• Ensure that all assigned cases have a follow up and that there are no duplicate follow ups.

• Address all follow ups promptly.

  • Alerts must be addressed within a day of receipt.

  • Initial call requests must be addressed within two days from the receipt of the follow up.

  • Follow ups should never be more than 14 days old.

• Hand any RUSH cases directly to the responsible party for review.

  • Appeals or submissions are due within two weeks from the date the due date was verified.

• Maintain one follow up in each assigned account and refrain from unnecessary duplicate follow ups on worklist.

• Indicate the referred amount of all first level administrative appeals filed through the daily worklist.

• Email and call Provider Representatives to resolve complex claim and appeal issues.

• Administrative duties or projects as assigned by a Partner or other member of management

• Follow all HIPAA guidelines in accordance with the Fotheringill & Wade, LLC Policy, Procedure, and Security Manual.

Supervisory and/or Administrative Responsibilities

• Approve cases eligible for clinical review through the use of the Medtrak tab.

• Assist with training of employees and provide necessary feedback as requested by management.

• Approve and review cases for external appeal and outpatient billing.

• Be an alternate point of contact for provider status inquiries.

• Review EOB’s and provider systems to obtain payment information and apply the proper payments to accounts for billing.

• Provide necessary employee feedback on Medtrak approvals, outpatient bill requests, external appeals and payments.

• Complete initial reviews as assigned.

• Communicate all employee issues or potential areas of concern to department supervisor immediately.

• Post received payments in Quantum Appeals and appropriate spreadsheets for accurate billing of clients.

• Maintain an understanding of how to utilize a multitude of hospital patient accounting systems (i.e.; Epic, Meditech, Eagle, and IDX) to accurately identify payments and retractions.

• Analyze payment postings and other documentation to determine insurance payment source or catalyst.

• Identify whether a claim has been under or over paid based on the provider’s expected reimbursement.

• Determine if underpayments are based on patient responsibility.

• Maintain an understanding of Maryland Health Services Cost Review Commission (HSCRC) payment rules.

• Maintain an understanding of DRG, per diem, case rates and other relevant insurance reimbursement schematics.

• Apply provider specific reimbursement methodologies, payment policies and provider contracts to each payment reviewed to confirm payment in full.

• Maintain an understanding of Electronic Remittance Summary Posting

• Meet all weekly performance standards and goals set by management.

• Bachelor's degree from four-year college or university with at least three years related experience; or five to seven years related experience and/or training; or equivalent combination of education and experience.

Working in an evolving healthcare setting, we use our shared expertise to deliver innovative solutions. Our fast-growing team has opportunities to learn and grow through rewarding interactions, collaboration and the freedom to explore professional interests.

Our associates are given valuable opportunities to contribute, to innovate and create meaningful work that makes an impact in the communities we serve around the world. We also offer a culture of excellence that drives customer success and improves patient care. We believe in giving back to the community and offer a competitive benefits package including:

• Comprehensive Medical, Dental, Vision & RX Coverage
• Paid Time Off, Volunteer Time & Holidays
• 401K with Company Match
• Company-Paid Life Insurance, Short-Term Disability & Long-Term Disability
• Tuition Reimbursement
• Parental Leave

R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.

If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.

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