Pros
Option to work from home
Cons
Worked for this company for many years. I have over 25 + years of medical experience in this field. The direction the company is taking is Quantity over Quality. Ensemble hires employees with no medical, experience and provides 2 weeks of training, with a click here, click there style of training without explaining the why behind the process. Unrealistic productivity goals! New hires meet productivity because they are not trained to look for the root cause of the denials. Little to no investigation is done on the accts, no actions are taken to resolve denials. The accounts are simply touched but not worked. Leaving the knowledgeable employees to fix all the mistakes, pick up the pieces, rework all accts, so the claims are processed for pmt. Without a decrease in productivity. The actual amt of time it takes to work a claim correctly is not calculated. All the quick touch accts are sent to an off shore vendor. They do not work the accounts correctly and have no access to call patients or payors. Accounts touched but not worked are given the same credit as the accounts that are actually worked. Productivity is not based on if the claim was actually paid, only that it was touched. The company's mentality is, if this person can touch this many claims, then everyone else should be able to as well. Without acknowleging, nothing was done to the acct to push for pmt. Only that it was touched. Which allows for aged AR. I have continuously provided examples of claims not being worked, at all, to leadership, but nothing has ever been done. I was told to stop sending examples. We are expected to obtain authorizations for high dollar accts that require a clinical background to obtain and can take over an hour to research medical records to answer the clinical questions. The RN's used to work these accts but they were too time consuming for them. Hiring more RN's to work clinical denials is too expensive for the company. So the job was dumped on us. The employees obtaining the authorizations DO NOT have a clinical background or any medical experience, causing the authorizations to deny. The end result, no pmts, accounts are written off. Did I mention that there is a dedicated claims rep to work no auth denials on the team, with a reduced productivity to work these time consuming accounts? But they do not have any no auth claims to work. The system to route claims to the no auth person has not worked in over 10 months. They will not allow us to route the claims to the person. There is no ETA as to when this issue will be fixed. Leaving the rest of the team to work no auth denials without reduced productivity. The untrained new hires simply skip the a accounts, leaving the hard accounts for the knowledgeable reps to work. There are only two knowledgeable reps on our team. The rest of the team, is friends or family of leadership. Not sure how long this can go on, when high dollar claims are not paid and written off. The clients will start to question this at some point. If applying for a job with this company, understand that you will be up against, friends and family of senior leadership. No matter what their experience level is, they will be promoted over you! They will be given opportunities that are not extended to you. They will be promoted with a simple tap on the shoulder. Job opportunities are not shared with the team, friends and family of leadership are just moved into open positions, leaving knowledgeable workers without a resource for help, should it be needed. If you care about the patient, and want to do everything you can to get claims paid. If you care about putting patients first. This is not the company for you!
