Ensures claims are paid appropriately pursuant to negotiated payment rates in Hospital's contractual agreements with all insurance payors. Evaluates and submits payment discrepancy disputes when appropriate. Essential Functions All team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health. Serve with compassion. Be the difference. Abides by all applicable policies, procedures, and guidelines of the Prisma Health System. Analyzes payor payments and collaborates with other departments to process appeals and resolve appropriate underpayments. This includes application of appropriate contract terms, fee schedules, identification of trends, and reporting trends to management. Research insurance credit balances/adjustments to ensure accuracy of transactions and appropriate disbursement of funds due to insurance payors. Ensures timely follow-up and appropriate action for assigned accounts. Reviews payor refund requests to resolve reimbursement discrepancies. Initiates appeals or adjustments based on contract interpretation, payor policies and procedures. Meets productivity and quality standards according to departmental policy. Troubleshoots claim pricing in Prisma Health's Information Systems and offers suggestions for improvement. Makes recommendations regarding complexity of claim resolution and the appropriateness of transferring account to collection vendor(s) or other resources for follow-up. Works with team members and management to participate and provide comprehensive training regarding appeals processing, process improvement, payor contracting and revenue cycle issues that impact reimbursement. Performs other duties as assigned.