Payer Account Resolution Specialist

Western Missouri Medical Center•Warrensburg, MO

8d•Onsite

About The Position

The Payer Account Resolution Specialist is responsible for ensuring claims have successfully transferred from the clearing house to the payer for adjudication. Provide any documentation as requested from payers in order to complete adjudication timely. Closely paying attention to timely file requirements. The Payer Account Resolution Specialist ensures claims are being received and adjudicated by payers within their timely filing limit, forming the foundation of the revenue cycle. This directly impacts cash flow, reduces delays, Timely File Adjustments and supports overall financial performance.

Requirements

High school diploma or equivalent.
2+ years of healthcare billing or revenue cycle experience.
Residency in Missouri or Kansas is required.
Experience working in an EHR system (MEDITECH preferred).
Basic understanding of CPT, HCPCS, and ICD-10 coding.
Basic understanding of insurance billing processes.
Basic 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.

Responsibilities

Monitor aging buckets >30 in which claims have been transmitted and have not been adjudicated.
Contact insurance companies via payer portal, payer chat or phone calls.
Monitor timely filing limits.
Document all account activities.
Locate missing remits and/or payments.
Resolve payer issue.
Submit requested documentation.
Coordinate any claim corrections needed with appropriate department.
Escalate complex issues.
Update any identified registration errors.
Identify opportunities for process improvement.
Research unpaid claims.
Communicate with leadership any trends that have been identified.
Keeping AR Days under 40 days.
Cash meeting or exceeding organization goal.
Keeping AR under 90 less than 25%.
Maintain regular and predictable attendance.
Perform other essential duties as assigned.