USPI

Role Description The remote Customer Service Specialist will be responsible for: - Receiving and triaging all incoming patient and insurance calls. - Initiating outbound calls and addressing questions and concerns regarding patient accounts through other platforms, as needed. - Working in real time with a patient on the line. - Answering phones and returning voicemails to callers. - Resolving written requests from an assigned worklist. - Conducting research into multiple files and systems, as well as collaborating with several departments. - Utilizing critical thinking and a thorough working knowledge of Revenue Cycle Management (RCM). - Meeting daily production benchmarks to help measure progress in meeting KPI’s. - Interacting professionally, promptly, and courteously with patients, internal teams, and surgery centers. - Assisting in working requests and resolving patient concerns. - Interpreting an Explanation of Benefits (EOB, RA, Remit) and reading the PAS Ledger and notes. - Multi-tasking, managing time effectively, and staying organized. - Accessing multiple systems and applications. - Being flexible to perform a variety of duties. - Bilingual is preferred. Qualifications - Prior experience in working with difficult or upset customers. - Collections experience is very helpful. - Prior A/R experience in a medical setting preferred. Requirements - Strong interpersonal skills. - Ability to conduct duties with empathy, support, respect, and professionalism. - Ability to evaluate and identify priority accounts. - Flexibility to perform additional delegated responsibilities and special assignments. Benefits - Daily production benchmarks to measure progress.

Role Description Reporting to the Hospital Collections Supervisor, the AR Team Lead supports the Accounts Receivable team by performing advanced insurance collections activities while providing peer-to-peer guidance and training to new hires. This role combines Level II and Level III AR responsibilities, including: - Resolution of complex and high-dollar claims - Contract review - Denial management - Escalation support The AR Team Lead serves as a subject matter resource for the team, assisting with onboarding, workflow prioritization, and best practices to ensure timely claim resolution and accurate reimbursement across all payer types. Qualifications - Experience in accounts receivable and insurance collections - Strong understanding of payer policies and AR workflows - Ability to mentor and train new hires - Excellent communication and problem-solving skills Requirements - Perform timely follow-up and resolution on outstanding A/R including unpaid, underpaid, or denied claims for all payer types including commercial, Medicare, Medicaid, and self-pay to maximize reimbursement. - Serve as a resource for functional training of new hires, offering ongoing guidance on daily responsibilities, workflow execution, and process clarification. - Partner with the Process Documentation Team to ensure documentation updates are approved and updated in a timely manner. - Partner with QA Team to ensure quality and productivity metrics are reported and consistently met. - Responsible for maintaining training materials and assisting with training content development based on QA results and team member education opportunities. - Manage and prioritize daily work queues with a focus on high-dollar and complex claim balances. - Investigate claim denials and underpayments, initiate appeals, and escalate issues when appropriate. - Review payer contracts, fee schedules, and explanation of benefits (EOBs) to ensure claims have been processed accurately. - Prepare and submit medical necessity appeals and supporting documentation when applicable. - Review medical records and clinical documentation to determine medical necessity and support appeal submissions. - Identify payer trends or reimbursement issues and communicate findings to leadership. - Facilitate communication with insurance carriers, patients, and internal departments including billing, coding, and payment posting to resolve outstanding balances. - Recommend account adjustments or refunds when overpayments or discrepancies are identified. - Provide peer-to-peer onboarding support and mentorship for new AR collectors. - Assist new hires in learning workflows, payer follow-up processes, and system navigation. - Share best practices for denial resolution, appeal preparation, and claim follow-up. - Serve as a subject matter resource for team members regarding payer policies, AR workflows, and claim resolution strategies. - Assist leadership in addressing complex claim issues and identifying workflow improvement opportunities. Company Description

Role Description The A/R Analyst reports to the Director of Operations and leads the analytical oversight of accounts receivable operations while providing strategic support to the A/R team. This role combines data analysis, process optimization, and team coordination through facilitating continuous training for established team members and newly hired team members and having an active role in End of Month processes to drive revenue cycle performance through evidence-based decision making. Responsibilities - Provides analytics & reporting to the Director of Client Operations through the following: - Conducts comprehensive A/R analysis including: - Denial management and root cause analysis - Out of period adjustment (OOPA) trends and impact assessment - Account inventory management and new facility onboarding audits - Cash flow optimization analysis - Payer behavior trending and pattern analysis - Develop and maintain analytical dashboards for key performance metrics - Facilitates the identification of issues and solutions by team members related to delays in achieving payment resolution - Completes routine Q/A reviews of work completed based on standard policies & procedures utilizing internal reporting tools - Ensures compliance with state and federal laws and regulations - Process Optimization & Strategy: - Serves as a Subject Matter Expert of A/R processes and reimbursement methodologies - Provides expert guidance on respective clients, regional payer trends and overall client specifics - Identify and implement improvements based on analytical findings - Coordinate with offshore team to optimize workflow and ensure data accuracy - Maintains thorough understanding of health insurance and government programs, when necessary - Team Development & Coordination: - Analyzes departmental training requirements and collaborates with the training team to implement data-driven quality assurance programs - Assists with onboarding and training new team members on A/R processes and reimbursement methodologies - Coordinate cross-functional initiatives between coding, billing, and cash applications teams - Monitors collection processes to determine cash flow improvement opportunities - Assists with generating, organizing and disseminating Month End reporting, narratives and summaries to clients Company Description

Role Description The RCM QA Analyst will be responsible for conducting audits across revenue cycle processes to ensure accuracy, consistency, and compliance. This role supports the success of a newly formed offshore team and established onshore teams by providing structured quality feedback and identifying opportunities for process and performance improvements. The analyst is expected to be cross-functional across RCM operations (insurance verification, billing, collections, cash applications, etc.), and will contribute directly to ensuring high-quality output from both onshore and offshore partners. Feedback from audits will be routed to department managers for formal coaching and development. Qualifications - Experience in revenue cycle management (RCM) processes. - Strong analytical skills. - Excellent communication skills. - Ability to work cross-functionally. Requirements - Perform audits on revenue cycle tasks and accounts to ensure accuracy and adherence to policies. - Participate in weekly, monthly, and quarterly audit cycles. - Document audit findings and maintain accuracy scores in shared tracking tools (initially Excel-based). - Collaborate with department managers to route and deliver feedback to team members. - Contribute to QA scorecards and help define audit metrics over time. - Remain up to date on RCM processes and maintain a working knowledge of all related systems. - Participate in calibration and audit consistency discussions. - Support ongoing training efforts by identifying knowledge gaps or recurring issues. - Help beta test or onboard future QA tools (e.g., Kaleidoscope, Advantx). - Other duties as assigned. Benefits - Competitive salary. - Health, dental, and vision insurance. - Retirement savings plan. - Opportunities for professional development.

Role Description The Payer Reimbursement Specialist is responsible for performing advanced Level 2 audits of payer contract loads, ensuring accuracy, compliance, and proper documentation across all centers. This role serves as a highly skilled technical resource, reviewing contract load accuracy. This position requires a seasoned A/R or reimbursement professional with strong managed care knowledge, exceptional organization, and the ability to work in a fast-moving, evolving environment. - Perform SOX Level 2 audits to validate contract load accuracy. - Review contract rate loads, contract types, MPRs, insurance carrier links, and contract grid updates. - Identify and document discrepancies, coordinate corrections with Managed Care Finance Ops. - Identify where contract grid updates are needed to communicate updates to payer reimbursement analysts, adding notes and ensuring accurate documentation for all audits. - Utilize and maintain tracking systems; monitor audit status and follow-up needs. - Assist in implementing improved tracking and workflow processes, including potential ticketing and intake solutions. - Communicate regularly with Analysts, Managers, and contract loaders to resolve audit findings. - Support special projects and other reimbursement initiatives. - Additional responsibilities assigned as needed. Qualifications - Strong managed care knowledge. - Exceptional organization skills. - Ability to work in a fast-moving, evolving environment. Requirements - Seasoned A/R or reimbursement professional. Company Description

Position Overview: Reporting to the Client Operations Manager, the Revenue Cycle Specialist - Collector must have a strong knowledge of medical collections, accounts receivables, insurance billing and verification, denial processing, appeal submission and EOB review. This position is responsible to resolve outstanding surgical claims resulting in maximum reimbursement. Responsibilities: - Timely follow-up and resolution on all outstanding A/R including unpaid/underpaid/denied claims for all payers including self-pay to obtain maximum reimbursement. - Manage daily work queue to prioritize high dollar claim balances. - Review & work incoming insurance and patient correspondence including refund requests. - Send appeals when appropriate or provide the requested medical documentation. - Ability to review medical documentation to justify medical necessity. - Review patient balances to ensure accuracy and follow up with patients to obtain payments. - Take incoming patient phone calls to resolve inquiries, billing issues, or outstanding balances. - Review insurance payments and determine accuracy of reimbursement based on contracts, fee schedules or summary plan documents. - Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCD’s) for claim resolution. - Negotiate payment amounts for procedures with Third Party Administrators for out of network providers. - Recommend an adjustment when applicable or recommend a refund for overpayments to insurance carriers or patients, providing the appropriate documentation.

Position Overview: Reporting to the Client Operations Manager, the Revenue Cycle Specialist - Collector must have a strong knowledge of medical collections, accounts receivables, insurance billing and verification, denial processing, appeal submission and EOB review. This position is responsible to resolve outstanding surgical claims resulting in maximum reimbursement. Responsibilities: - Timely follow-up and resolution on all outstanding A/R including unpaid/underpaid/denied claims for all payers including self-pay to obtain maximum reimbursement. - Manage daily work queue to prioritize high dollar claim balances. - Review & work incoming insurance and patient correspondence including refund requests. - Send appeals when appropriate or provide the requested medical documentation. - Ability to review medical documentation to justify medical necessity. - Review patient balances to ensure accuracy and follow up with patients to obtain payments. - Take incoming patient phone calls to resolve inquiries, billing issues, or outstanding balances. - Review insurance payments and determine accuracy of reimbursement based on contracts, fee schedules or summary plan documents. - Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCD’s) for claim resolution. - Negotiate payment amounts for procedures with Third Party Administrators for out of network providers. - Recommend an adjustment when applicable or recommend a refund for overpayments to insurance carriers or patients, providing the appropriate documentation.

Position Overview: Reporting to the Director of Client Operations, the Client Operations Manager is responsible for ensuring best practice and optimal revenue cycle results for assigned CBO clients, with direct oversight of 8-12 clients. The Client Operations Manager is accountable to client and employee satisfaction, KPI and other client performance results and collaborating internally and externally to drive revenue cycle and reimbursement initiatives. This role develops an environment and culture that embraces continuous improvement and innovation to ensure best practices are achieved in all areas of the revenue cycle. They will lead a team of A/R Specialists to ensure maximized collectability of services performed. Ensuring that internal policies and practices support the operational quality, efficiency, and compliance of all standard practices. They will coordinate with other cross functional areas that impact or support RCM to ensure appropriate collaboration and system wide efficiency of operations while providing oversight and employee development for direct reports. Responsibilities: - Manages a team of 6-10 employees who complete the accounts receivable functions resulting in revenue generation. - Continuously evaluates and is expected to be actively involved in ensuring all revenue cycle operations are well-managed, delivering excellence in quality standards, consistently meeting the organizations and client expectations. - Facilitates the identification of issues and solutions by team members related to delays in achieving payment resolution. - Monitors collection processes to determine cash flow improvement opportunities. - Manages the aging of accounts receivable by trending and analyzing the A/R, and thorough communication with payers. - Manage the implementation of key strategies; fostering an environment of accountability to create a high performing team. - Successfully communicates trends, issues, resolutions as well as proactively communicates opportunities to clients. - Must become expert on respective clients, regional payer trends and overall client specifics. - Maintains thorough understanding of health insurance and government programs, when necessary. - Assist assigned staff in establishing daily/weekly workflows to accomplish KPIs. - Manage assignments across entire team to meet employee productivity and collection efforts across all client facilities. - Provides analysis, reporting, and recommendations for revenue performance in key metrics including billing, collection, and posting, such as A/R aging’s, volumes, and trends. - Conduct routine quality assurance reviews of work completed; initiate coaching measures as needed. - Evaluate the audit findings, creating and establishing baselines and expectations to measure improvements. - Leverage audit findings to identify training needs for system education, industry updates and changes in collections processes and protocols. - Provide training for newly hired and existing employees to generate consistent team output.

Reporting to the Director of Centralized Insurance Verification – Enterprise RCM, the Insurance Verification Support Specialist-Enterprise is responsible for verifying insurance coverages, obtaining initial Preauthorization’s and ensuring accurate data collection and entry for assigned locations. The IV Support Specialist will use their knowledge to help drive the streamlining of processes and delivering efficient insurance verification services.

Reporting to the Director of Centralized Insurance Verification – Enterprise RCM, the Insurance Verification Support Specialist-Enterprise is responsible for verifying insurance coverages, obtaining initial Preauthorization’s and ensuring accurate data collection and entry for assigned locations. The IV Support Specialist will use their knowledge to help drive the streamlining of processes and delivering efficient insurance verification services.