Emerus is the nation’s first and largest operator of small-format hospitals, also known as community or neighborhood hospitals. Emerus’ leading national health system partners include Allegheny Health Network, Ascension, Baptist Health System, Baylor, Scott & White Health, Dignity Health St. Rose Dominican, The Hospitals of Providence, INTEGRIS and MultiCare. Our state-of-the-art hospitals are fully accredited and provide highly individualized care. From the moment a patient walks through the door, a team of exceptional medical professionals takes charge, treating patients with speed, compassion and expertise. Emerus’ distinctive level of care earned the Guardian of Excellence Award for Superior Patient Experience in six of the past seven years. More information is available at www.emerus.com.

The purpose of this position is to assist in managing the company’s outstanding receivables, through routine communication with all payers (e.g. commercial insurance, Medicare, private pay patients, etc.) to ensure that expected reimbursement for patient care is processed timely and paid accurately.  

• Follow up on submitted claims (i.e., claim received, pending, processing, paid, etc.) and complete action as appropriate to ensure timely receipt and appropriate reimbursement
• Communicate with payers regarding delinquent or denied claims, addressing issues and clearing barriers to payment
• Manage claim details and verify accurate reimbursement, so as to initiate account adjustments and/or appeals on payment disputes 
• File appeals for denied claims and follow-up as necessary through appeal resolution
• Manage and maintain outstanding patient balances to ensure accurate reporting of company’s accounts receivable
• Utilize on-line/telephonic resources to verify benefits and ensure claims are processed according to the appropriate benefit levels
• Submit refund requests as necessary
• Works special projects as assigned by Supervisor/Director/CFO

• Meet position’s goals and objectives related to accuracy and productivity (e.g. days in AR, cash collections, etc.)
• Attend staff meetings or other company sponsored or mandated meetings as required
• Perform additional duties as assigned
• Willingness and ability to work overtime

• High School Diploma or GED, required
• 2+ years experience in a provider setting (inpatient or outpatient), required
• Knowledge of all payors insurance; self-pay after insurance, reimbursements, collections, appeals, claims follow-up and third party billing, required
• Experience with medical records or patient accounting systems, required
• Knowledge and understanding of state and Federal payment laws, required
• Knowledge and understanding of healthcare ‘explanation of benefits’ (EOB’s), required
• Experience with a 10-key adding machine, required

• Position requires fluency in English; written and oral communication