Payer Account Resolution Specialist

Western Missouri Medical Center•Warrensburg, MO

About The Position

The Payer Account Resolution Specialist ensures claims are successfully transferred from the clearinghouse to payers and received and adjudicated within payer timely filing limits. The role provides documentation requested by payers to support timely adjudication and helps establish a strong revenue cycle foundation. Its work affects cash flow, reduces delays and timely filing adjustments, and supports overall financial performance. The specialist monitors transmitted but unadjudicated claims, researches unpaid claims, resolves payer issues, locates missing remittances or payments, and coordinates claim corrections with the appropriate departments. The role documents account activity, escalates complex issues, identifies process improvements and communicates trends to leadership. Performance expectations include keeping AR days under 40, keeping AR over 90 days below 25%, meeting or exceeding the organization’s cash goal, and maintaining regular and predictable attendance. Other essential duties may be assigned.

Requirements

High school diploma or equivalent.
At least 2 years of healthcare billing or revenue cycle experience.
Current residency in Missouri or Kansas.
Experience working in an EHR system.
Basic understanding of CPT, HCPCS, and ICD-10 coding.
Basic understanding of insurance billing processes.
Understanding of Explanation of Benefits.
Attention to detail and accuracy.
Time management and ability to meet deadlines.
Strong organizational skills.
Effective communication and teamwork.
Ability to follow standardized workflows.

Nice To Haves

MEDITECH EHR experience is preferred.

Responsibilities

Monitor aging buckets over 30 days for claims that have been transmitted but not adjudicated.
Contact insurance companies through payer portals, payer chat, or phone calls.
Monitor timely filing limits.
Document all account activities.
Locate missing remittances and/or payments.
Resolve payer issues.
Submit documentation requested by payers.
Coordinate needed claim corrections with the appropriate department.
Escalate complex issues.
Update identified registration errors.
Identify opportunities for process improvement.
Research unpaid claims.
Communicate identified trends to leadership.
Meet performance expectations for AR days, cash, and AR over 90 days.
Maintain regular and predictable attendance.
Perform other essential duties as assigned.