Payment Resolution Specialist

The Payment Resolution Specialist is responsible for review and resolution of outstanding missing payment insurance balances for hospital patient accounts. The Payment Resolution Specialist is required to learn multiple clearinghouses and/or applications, conduct research, work missing payments in pursuit of resolving outstanding accounts in which insurance payments have been issued by the payor but are not posted to the patient account, as well as accurately post previously mentioned transactions to the appropriate accounts once identified. The primary responsibility of a Payment Resolution Specialist is to complete tasks related to timely resolution of accounts receivable for specific accounts which have been identified as paid by the payor but are still showing as outstanding in AR. Secondary responsibilities include serving as cash posting backup, when necessary, as determined by Cash Posting Leadership.

Key Requirements

• Conduct a thorough investigation into the root cause of any missing payments to ensure that all transactions are accurately applied to the correct patient accounts.
• Research missing payment reports weekly to ensure accurate missing payment inventory and timely review.
• Work a minimum of 15-20 accounts per day.
• Reconcile and perform insurance cash posting within the system to resolve missing payments with deposit confirmation.
• Communicate clearly and concisely with insurance companies about any missing payment deposit details.
• Collaborate internally and with facility contacts to identify and communicate trends of missing payments, such as issues with ERA/EFT payor enrollment, insurance payments being sent to the wrong entity, remit reconciliation discrepancies, etc.
• Completes timely follow-up on assigned accounts, documents research findings in detail and notate next steps towards resolution.
• Participate and complete projects assigned by Cash Posting Leadership to fulfill clients’ contractual agreement of services.
• Ability to prioritize job responsibilities and manage time effectively for completion of assignments.
• Attend role-based education courses within the calendar year.
• Performs other duties as assigned by Cash Posting Leadership.

Administrative Duties:

• Accurately input/submit worked time by the required departmental deadlines.
• Maintain basic knowledge of insurance payors, reading/interpreting insurance remits, and collection regulations.
• Maintain basic industry knowledge through self-study and by attending training classes.
• Attend and participate in team and departmental meetings.
• Responds promptly and professionally to emails, phone calls, voicemails, Microsoft Teams messages, and correspondence from patients, agencies, and facilities, including facility Executive Leadership.
• Adherence to all HIPAA Privacy and Security requirements and responsibilities.  
• Perform duties and responsibilities in a positive manner that upholds company policies and procedures.

Knowledge, Skills, and Abilities:

• Knowledge of computer applications or other automated systems, such as excel spreadsheets, word, email, and data base software in working assignments.
• Proficiency with telephone systems for outbound/inbound calls.
• Access protected health information (PHI) in accordance with departmental assignments and guidelines.
• Skilled in making accurate arithmetic computations.
• Excellent communication, good judgment, tact, initiative, and resourcefulness.
• Must be detail oriented, organized, and ability to multi-task.
• Possess ability to concentrate for long periods of time.
• Ability to work individually and/or as part of a team.
• Ability to demonstrate supportive relationships with peers, clients, partners, and corporate executives.
• Must be flexible with a “can do” attitude and the ability to remain professional under high pressure situations.
• Demonstrates the ability to learn new systems quickly and develop proficient operating skills within a reasonably short timeframe.
• Understand oral and written directives.

Training and Experience:

• High School or equivalency diploma required.
• 5+ years’ experience in related field.
• Must be able to follow directions and to perform work according to department standards independently.
• Must be able to function effectively under high pressure situations.
• Customer Service oriented.

Other Requirements:

• High Speed Internet access and unlimited data.
• Smart phone for DUO authentication.
• Criminal and MVR backgrounds meet our company hiring criteria.