Payment Resolution Specialist
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POST DATE 9/15/2016
END DATE 11/5/2016
JOB DESCRIPTIONJob Summary:
The Payment Resolution Specialist provides financial, administrative and clerical services to ensure accuracy and efficiency of operations. The Payment Resolution Specialist is responsible for processing and monitoring incoming payments and securing revenue by verifying and posting payments and Account follow-up and/or grievance preparation of assigned Client Hospital Accounts Receivable. Working at a Client site or in a Centralized location, responsibilities may include account maintenance of specialized or multiple payers including state and federal government programs, managed care, commercial and other insurance groups. The Payment Resolution Specialist may serve as a liaison to clinical auditors, other team members, hospital staff, government agencies and health plans to facilitate the appropriate and prompt payment of claims. This individual must demonstrate a commitment to the organization's strategic plans, short and long term goals and mission, vision and values by representing the company in a caring and professional manner. Primary / Essential Functions:
* Approve all billable accounts in hospital and internal database by ensuring data entered is correct and update status correctly
* Verify eligibility is accurate and program will cover services provided and is for correct dates of service
* Review account to determine if account needs Authorization.
* Verify that account balance and dates of service are accurate
* Notifies client of approvals to initiate the billing process.
* Enter payments into database and update database timely to reflect payments/adjustments
* Researches all account information on paid or partially paid claims and analyzes the status of the payment related to the expected payment calculation and itemization provided by the remittance advice
* Analyzes any denied, disallowed or non-covered claims and determines if non-payment is based on medical or technical reasons
* Prepares claims for clinical audit processing in the case of authorization, coding, level of care and/or length of stay denials
* Knowledge of Government eligibility program requirements is highly desirable.
* Excellent communication skills, both verbal and written, with the ability to understand users' questions and effectively disseminate technical information are essential.
* Minimum of 1 to 3 years with computer data entry, clerical and word processing experience.
* Working knowledge of computer programs, i.e., Microsoft Excel .
* Must be able to type at least 30 wpm.
* Ability to operate a multi-line telephone system.
* Strong organizational and coordination abilities are required