Account Resolution Analyst

Yale New Haven Health • New Haven, CT

9h

About The Position

The Account Resolution Analyst handles high volumes of third-party claims and ensures accurate information is submitted to payers in a timely manner through clearing houses or payer intermediaries. The role resolves claim submission problems, follows up on paid and unpaid claims, and carries out work needed to resolve inpatient and outpatient balances. It documents account activity, identifies claim-edit and rejection trends, and reports issues to the supervisor.

The analyst maintains knowledge of medical billing requirements, payer payment methodologies, self-pay billing guidelines, and relevant federal, state, and insurance regulations. The position also supports departmental goals through participation in meetings, training, seminars, and workgroups, and performs other duties as requested by the supervisor.

Requirements

• High school diploma.
• 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.
• 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 clearing houses or payer intermediaries.
• Correct problems preventing claim submission, contact responsible individuals to take corrective action, and document actions.
• Complete daily claims submissions within the supervisor-designated timeframe.
• Resubmit claims with updated or corrected information as requested by the department.
• Resolve third-party payer clearing house rejections daily and report trends in claim edits and rejections to the supervisor.
• Follow up on paid and unpaid claims to expedite accurate payment, determine reasons for nonpayment, and take appropriate action.
• Communicate with third-party payers, self-pay patients, and internal hospital departments, primarily by telephone and web-based methods.
• Resolve inpatient and outpatient credit balances according to departmental procedures and post adjustments as needed to maintain account integrity.
• Maintain knowledge of medical billing requirements, payer payment methodologies, self-pay billing guidelines, and relevant regulatory changes.
• Identify problem and delinquent accounts after collection avenues have been exhausted and advise the supervisor when intervention is needed.
• Recognize account-resolution problem areas and trends and suggest improvements.
• Participate in staff meetings, seminars, training sessions, and workgroups to advance departmental goals.
• Perform other duties as requested by the supervisor.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED