Account Resolution Analyst

Yale New Haven Health•New Haven, CT

About The Position

The Account Resolution Analyst manages a high volume of third-party claims to help ensure accurate, timely submission to payers and prompt payment. The role corrects or routes claim submission issues, follows up on paid and unpaid claims, resolves clearinghouse rejections, and documents account activity clearly. The analyst also resolves inpatient and outpatient balances, posts adjustments as needed, and identifies claim-edit, rejection, and account-resolution trends for supervisor review. The position requires general knowledge of the revenue cycle, medical billing requirements, payer payment methodologies, self-pay billing guidelines, and applicable federal, state, and insurance regulations. The analyst also contributes to departmental goals through meetings, training, workgroups, and improvement suggestions, and performs other duties as requested by the supervisor.

Requirements

High school diploma required.
One to two years of third-party claims management and/or billing experience in a computerized hospital or healthcare revenue-cycle environment.
Extensive knowledge of third-party insurance carriers and their billing and reimbursement requirements.
Excellent analytical and organizational skills.
Ability to perform detailed analysis quickly and accurately in a high-volume, fast-paced environment.
Ability to communicate effectively in writing and verbally.
Proven ability to navigate payer websites and other web-based applications.

Nice To Haves

Associate degree in a business-related field.
Experience with Epic.
Microsoft Office skills.

Responsibilities

Handle a high volume of third-party claims and ensure accurate information is submitted to payers through clearinghouses or payer intermediaries.
Identify and correct problems preventing claim submission, coordinate corrective action with responsible individuals, and document actions.
Complete daily claim submissions within the supervisor-designated timeframe and resubmit claims with updated or corrected information as requested.
Resolve third-party payer clearinghouse rejections daily and identify and report trends in claim edits and rejections to the supervisor.
Follow up on paid and unpaid claims according to department workflows, determine reasons for nonpayment, and take appropriate action to resolve claims and expedite payment.
Document account follow-up activities clearly and concisely, using telephone, web-based communication, and internal coordination with hospital departments.
Resolve inpatient and outpatient credit balances according to departmental procedures and post adjustments as required to maintain account integrity.
Maintain general knowledge of medical billing requirements, payer payment methodologies, self-pay billing guidelines, and changes to federal, state, and insurance regulations.
Identify problem and delinquent accounts after exhausting collection avenues and advise the supervisor when intervention is needed.
Recognize account-resolution issues and trends, suggest improvements, and participate in staff meetings, seminars, training sessions, and workgroups.
Perform other duties as requested by the supervisor.