Ventra Health
Website:
ventrahealth.com
Job details:
Ventra is a leading business solutions provider for facility-based physicians practicing anesthesia, emergency medicine, hospital medicine, pathology, and radiology. Focused on Revenue Cycle Management, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions that solve the most complex revenue and reimbursement issues, enabling clinicians to focus on providing outstanding care to their patients and communities.
Come Join Our Team!
- As part of our robust Rewards & Recognition program, this role is eligible for our Ventra performance-based incentive plan, because we believe great work deserves great rewards
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Job Summary
- The SCCIPA Specialist is responsible for completing routine SCCIPA claim adjudication work according to established workflows and payer requirements. This role reviews assigned claims, verifies claim and authorization information, enters adjudication outcomes accurately, documents claim activity, and identifies items requiring follow-up or escalation.
- The SCCIPA Specialist is expected to maintain accurate claim status updates, complete assigned adjudication work timely, and escalate claims that cannot be resolved through standard processes.
Essential Functions And Tasks
Claim Adjudication
- Review assigned SCCIPA claims and complete adjudication activity according to established procedures.
- Verify claim details, authorization information, payer responses, and supporting documentation before completing adjudication.
- Enter adjudication outcomes accurately in the appropriate system or tracking tool.
- Identify claims that are pending, denied, underpaid, missing information, or otherwise unable to be adjudicated.
- Document adjudication notes, status updates, pending reasons, and next steps clearly and consistently.
- Follow established SCCIPA workflows for claim adjudication, follow-up, and escalation.
Authorization & Claim Validation
- Compare claim information against available authorization records to confirm accuracy before adjudication.
- Identify missing, incomplete, or mismatched authorization information.
- Document authorization discrepancies that impact claim adjudication.
- Follow standard steps to resolve routine authorization-related issues.
- Escalate authorization concerns that cannot be resolved through the standard workflow.
Denial & Pending Claim Follow-Up
- Review assigned denied or pending SCCIPA claims and update claim status information accurately.
- Identify basic denial or pending reasons based on payer response, authorization status, and claim documentation.
- Gather and document claim details needed for additional review.
- Track follow-up activity, including pending responses, reversal requests, corrected information, or unresolved items.
- Escalate complex denials, repeated issues, or claims requiring further review to the SCCIPA Analyst or leadership.
Documentation & Accuracy
- Maintain complete and accurate notes for all assigned claim adjudication activity.
- Ensure systems and trackers are updated timely and consistently.
- Follow established naming, status, and documentation standards.
- Review work for accuracy before marking claims complete.
- Communicate unclear items or process questions to the SCCIPA Analyst or leadership.
Productivity & Follow-Up
- Complete assigned SCCIPA adjudication work queues within expected timeframes.
- Prioritize work based on aging, pending status, payer response, and assigned deadlines.
- Follow up on outstanding adjudication items until resolved or escalated.
- Assist with assigned recheck, audit, or cleanup work related to SCCIPA claim adjudication.
- Maintain consistent productivity while ensuring accuracy and documentation quality.
Education And Experience Requirements
- Experience in healthcare revenue cycle, medical claims, payment posting, adjudication, billing, collections, authorizations, or denial follow-up preferred.
Knowledge, Skills, And Abilities
- Strong attention to detail and ability to enter and document claim information accurately.
- Ability to follow established adjudication workflows and work assigned queues independently.
- Basic understanding of claim status, payer responses, denials, authorizations, and payment/adjustment activity.
- Basic proficiency in Excel, claim systems, spreadsheets, and tracking tools.
- Ability to identify when a claim requires escalation for additional review.
Compensation
- Base Compensation will be based on various factors unique to each candidate including geographic location, skill set, experience, qualifications, and other job-related reasons .
- This position is also eligible for a discretionary incentiv e bon us in accordance with company policies .
Ventra Health
Equal Employment Opportunity (Applicable only in the US)
Ventra Health is an equal opportunity employer committed to fostering a culturally diverse organization. We strive for inclusiveness and a workplace where mutual respect is paramount. We encourage applications from a diverse pool of candidates, and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, religion, sex, age, national origin, disability, sexual orientation, gender identity and expression, or veteran status. We will provide reasonable accommodations to qualified individuals with disabilities, as needed, to assist them in performing essential job functions.
Recruitment Agencies
Ventra Health does not accept unsolicited agency resumes. Ventra Health is not responsible for any fees related to unsolicited resumes.
Solicitation of Payment
Ventra Health does not solicit payment from our applicants and candidates for consideration or placement.
Attention Candidates
Please be aware that there have been reports of individuals falsely claiming to represent Ventra Health or one of our affiliated entities Ventra Health Private Limited and Ventra Health Global Services. These scammers may attempt to conduct fake interviews, solicit personal information, and, in some cases, have sent fraudulent offer letters.
To protect yourself, verify any communication you receive by contacting us directly through our official channels. If you have any doubts, please contact us at Careers@VentraHealth.com to confirm the legitimacy of the offer and the person who contacted you. All legitimate roles are posted on https://ventrahealth.com/careers/.
Statement of Accessibility
Ventra Health is committed to making our digital experiences accessible to all users, regardless of ability or assistive technology preferences. We continually work to enhance the user experience through ongoing improvements and adherence to accessibility standards. Please review at https://ventrahealth.com/statement-of-accessibility/.
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