Denials Operations Associate - Lehi, United States - Athelas

Description

Job Description

Every day, it feels like healthcare becomes less about the practice of medicine. Hospitals and private practices operate on razor-thin margins, caught between the bureaucracy of insurance companies and ballooning administrative costs. And technological advancements — from electronic health record systems to dictation software — have failed to live up to their promise of making the lives of all healthcare staff easier.

Athelas' mission is to once again make health the focus of healthcare by using AI and automation to eliminate distractions and keep providers connected to their patients throughout the care journey.

The Athelas suite of automated and AI-enabled hardware, software, and services results in happier and healthier patients, less time wasted on administrative tasks, safer staff, and more reliable insurance reimbursements. Since merging with Commure, our growing suite of solutions now includes:

• Patient Engagement - Commure Engage empowers providers to connect with their patients throughout the care journey, reducing no-shows and improving health outcomes
• Workflow Automation - PatientKeeper and other workflow tools automate repetitive tasks, allowing healthcare workers to spend more time with patients
• Staff Safety - Commure Strongline protects staff from workplace violence by empowering them to call for help to de-escalate potentially violent situations
• At-Home Monitoring - Athelas Care Management offers a suite of remote sensors that allow doctors to bring healthcare into the home, saving lives through early intervention
• Billing Solutions - Athelas RCM offers AI-driven, full-cycle revenue cycle management solutions that optimize claims submission, ensuring insurers pay every dollar they owe for work performed by healthcare providers
• Automated Dictation - Athelas Scribe utilizes the power of LLMs to record and automatically summarize appointments, saving doctors countless hours every day

Athelas takes a provider-focused approach to healthcare and the healthcare industry has noticed. We've grown more than 500% year over year for three consecutive years. We support more than 250,000 clinicians and staff and hundreds of thousands of patients across hundreds of care sites. And we're just getting started. Backed by General Catalyst, Sequoia, and many other leading investors, Athelas & Commure is positioned to be the defining healthcare tech company of the next 15 years.

If you're eager to advance our mission to make health the focus of healthcare, come join us

About the Role

Our team is looking for a Denials Operations Associate who will be an essential part of our Denials Operations team. You will have end-to-end ownership - ensuring efficient execution and driving business metrics. This is an incredibly high-visibility, high-impact, high-autonomy role that will quickly expand to cover more and more emergent business problem areas. Successfully navigating and solving our hyper-growth challenges will lead to rapid growth in role and responsibility. There is no ceiling.

Location: Must be able to do hybrid work in our Lehi, Utah office.

Required:

• At least 1 year of denials experience in healthcare or a related field

What You'll Do

• Claims Management:
  • Handle the end-to-end process of claims management, including submission, tracking, and resolution.
  • Proactively call payers to gather information, verify claim status, and address denials promptly.
• Denial Debugging:
  • Investigate and debug claim denials to identify root causes and develop effective resolution strategies.
  • Collaborate with internal teams to address recurring denial issues and implement preventive measures.
• Claim Resubmission:
  • Take ownership of the claims resubmission process, ensuring accuracy and compliance with payer requirements.
  • Develop a systematic approach to streamline the resubmission workflow and minimize errors.
• Metric Ownership:
  • Manage and own performance metrics for a designated subset of accounts.
  • Regularly analyze metrics, identify trends, and implement improvement strategies to enhance overall operational efficiency.
• Cross-Functional Collaboration:
  • Work closely with product teams to understand system functionalities and contribute to the development of tools that improve operational workflows.
  • Collaborate with engineers to address technical challenges and enhance the overall operations infrastructure.
• Continuous Improvement:
  • Actively seek opportunities for process improvement and efficiency gains within the operations workflow.
  • Provide feedback on existing processes and contribute ideas for enhancing overall team productivity.
• Documentation and Reporting:
  • Maintain accurate and detailed documentation of all interactions, resolutions, and updates related to claims and denials.
  • Generate regular reports on key performance indicators and present findings to the team.
• Communication Skills:
  • Effectively communicate with internal and external stakeholders, ensuring clarity and transparency in all interactions.
  • Collaborate with team members to share insights, best practices, and updates on payer policies.
• Compliance and Regulation:
  • Stay informed about changes in healthcare regulations and payer policies.
  • Ensure all operations activities adhere to compliance standards and guidelines.
• Team Collaboration:
  • Actively participate in team meetings, share insights, and contribute to a positive and collaborative team culture.
  • Assist team members as needed and foster a supportive and cohesive working environment.

Why You'll Like Working with Athelas

• Execution focused, driven team: Join a team with an incredible record - we are the smallest, fastest company in history to receive FDA hematology clearance. We are also the largest Remote Patient Monitoring company in the US, with a fast-growing SaaS Revenue Cycle Management business as well
• Technology Focus: Revolutionizing how technology can be used in the healthcare industry
• Strong Backing: $132M Series B raised from the likes of Sequoia, General Catalyst, Tribe, Y Combinator
• Mission Driven: We are changing the way healthcare is provided, bringing it directly to the people who need it with technology-enabled solutions
• Incredible Growth: Revenue growth of 5x over the past 6 months and we're just getting started
• Competitive Benefits: Unlimited PTO, medical, dental, vision, excellent maternity and paternity paid time off.

Athelas is committed to creating and fostering a diverse team. We are open to all backgrounds and levels of experience, and believe that great people can always find a place. We are committed to providing reasonable accommodations to all applicants throughout the application process.

Employees will act in accordance with the organization's information security policies, to include but not limited to protecting assets from unauthorized access, disclosure, modification, destruction or interference nor execute particular security processes or activities. Employees will report to the information security office any confirmed or potential events or other risks to the organization.

Employees will be required to attest to these requirements upon hire and on an annual basis.

Compensation Range: $50K - $60K