Ops Associate I

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, patients 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 Operations Associate I will be responsible for working directly with healthcare insurance companies to ensure hospital claims are processed. This person will perform resolution analysis including reviewing health information systems, knowledge resources, state or federal legislation, claims billing, and clinical information to effectively reconcile accounts.

In this role, Operations Associates work directly with their Senior Associate, teammates, and internal solution line teams and stakeholders. Operations Associates are expected to meet productivity metrics and maintain current resolution efforts on all their assigned projects. This is an excellent opportunity to work in a professional setting with a comprehensive in-house training program. The position also provides performance-based evaluations with opportunity for advancement.

Responsibilities:

• Conduct follow-up calls & payer portal escalations with insurance payers to resolve hospital claims and maximize revenue for hospital clients.
• Maintain timely, professional follow-up and demonstrate a wide knowledge base of the solution line, payer behavior, health information systems, claims processing, and revenue cycle.    
• Document all communication and actions taken during payer escalations for future reference and tracking purposes.
• Analyze and interpret denial data to develop evidence-based responses for claim/appeal denials to ensure contractual payment of submitted claims.
• Perform continual analysis and quality control of solution line opportunities.
• Collaborate with cross-functional teams, key stakeholders, and upper management to optimize revenue on accounts.
• Maintain a thorough understanding of payer policies, guidelines, and regulations to ensure compliance and maximize revenue.
• Analyze payer trends and patterns identified during payer interactions identify opportunities for process improvement and implement effective solutions.
• Stay abreast of continual R1 platform development and enhancements to effectively manage account information and workflow.
• Maintain a high level of professionalism and customer service during all payer interactions to build and maintain positive relationships with insurance payers.

Required Qualifications:

• A Bachelor's degree in Healthcare Administration, Business, or related field or High School diploma with 2+ years' of experience in revenue cycle management, billing, or healthcare finance.
• Exceptional critical thinking and analytical skills with the ability to identify patterns, trends, and root causes.
• Ability to think on your feet and make informed decisions in a fast-paced environment.
• Excellent written and verbal communication skills, with the potential to formulate clear and concise appeals.
• Detail-oriented with a high level of accuracy and attention to detail.
• Proficient in using Microsoft Office Suite (Word, Excel, PowerPoint) and other relevant software applications.
• Experience with revenue cycle management systems and electronic health records (EHR) preferred.
• Knowledge of coding systems (e.g., CPT, ICD-10) and medical terminology is a plus.
• Self-starter who is eager to learn, and can work independently and in a team environment