United States onlyR1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration.
Position Summary
A plan/payer escalation role involves understanding basic concepts of hospital/physician billing principles, the ability to navigate payor guidelines, the ability to analyze, formulate, and initiate actions to resolve claims/issues, and the overall escalation of claim issues with payors when necessary.
Essential Responsibilities
Responsibilities of a plan/payer escalation specialist include but are not limited to the ability to:
- Understand and navigate payor guidelines (portals, manuals, contracts, etc.)
- Research and interpret contract terms along with compiling necessary supporting documentation to obtain resolution of outstanding AR.
- Identify and escalate claim issues with payors and external or internal stakeholders, when appropriate.
- Analyze data for identification and monitoring of payer trends, managed care / contract compliance, and operational processes specific to R1 and the respective client being serviced.
- Follow payer specific guidelines for escalated claim(s) submission.
- Work closely with leadership to optimize payer performance and resolve escalated issues efficiently
- Collaborate with various departments/teams to handle escalated issues and prevent future escalations where possible.
- Provide feedback to global partners/clients, fellow associates, and other impacted departments, as applicable.
- Identify and review the root cause of escalation(s) to improve AR collections and escalation procedures.
- Support internal and external customers by responding to and managing complaints and escalations.
- Solve moderately complex problems and time sensitive inquiries.
- Decipher payer specific escalation files with payer responses and determine next steps for achieve resolution.
- All other duties as assigned.
Skills
- Self-motivator with ability to work in remote environment with minimal supervision
- Analytical and problem solving/critical thinking skills
- Excellent working knowledge of Revenue Cycle Services operations with specific focus on Inpatient and Outpatient Managed Care and Commercial payors
- Proficient in Microsoft Office Suite (Word, Excel, and Outlook)
- Ability to implement process improvements based on the directives of leadership.
- Ability to multi-task and manage various demanding assignments that at times may conflict.
- Ability to independently troubleshoot system challenges for resolution.
- Strong organizational skills
- Proficient written and verbal communication skills
Other Qualifications
Proficient computer skills (including, but not limited to, spreadsheets, Internet, and email) are required.
- High School Diploma or Equivalent from accredited program.
- 1-3 years of experience supporting hospital staff or other applicable health field.
- Ability to work with multiple lines of leadership.
- Must have work experience with Microsoft office products including PowerPoint, Excel, Outlook and Word.
- Excellent written and verbal communication skills.
- Medical Terminology knowledge is preferred.
- Knowledge of revenue cycle, patient access, patient registration systems, billing, and collections
Education and Experience
Education Level High School Diploma
Experience Level 1-3 years experience
For this US-based position, the base pay range is $43,888.00 - $70,631.44 per year . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.This job is eligible to participate in our annual bonus plan at a target of 5.00%The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career.
Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team — including offering a competitive benefits package.
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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