Acct Resolution Analyst

Yale New Haven Health•New Haven, CT

22d

About The Position

The Acct Resolution Analyst handles high volumes of third-party claims and ensures accurate information is submitted to payers through clearing houses or payer intermediaries in a timely manner. The role corrects claim-submission issues, coordinates corrective action with responsible individuals, documents account follow-up, and identifies claim-edit and rejection trends for the supervisor. The analyst resolves individual inpatient and outpatient balances and follows departmental procedures for account adjustments. The position follows up on paid and unpaid claims to support prompt, accurate payment, determines reasons for nonpayment, and takes appropriate steps to resolve claims. Communication is conducted by telephone and web-based methods with payers, self-pay patients, and internal hospital departments. The analyst maintains general knowledge of medical billing requirements, payment methodologies, self-pay billing guidelines, and applicable federal, state, and insurance regulations, and participates in activities supporting departmental goals.

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.
Ability to navigate payer websites and other web-based applications.

Nice To Haves

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

Responsibilities

Handle high volumes of third-party claims and ensure accurate information is submitted to payers through clearing houses or payer intermediaries.
Correct issues that prevent claim submission, coordinate corrective action with responsible individuals, and document actions.
Complete daily claims submission within the timeframe designated by the supervisor.
Resubmit claims with updated or corrected information based on departmental requests.
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 according to department workflows, determine reasons for nonpayment, and take appropriate action to resolve claims.
Document all account follow-up activities clearly and concisely, using telephone and web-based communication with payers and self-pay patients and communicating with internal hospital departments as needed.
Resolve individual inpatient and outpatient credit balances according to departmental procedures and post adjustments as required to maintain account integrity.
Maintain 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 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.