Account Resolution Specialist

Minimum Qualifications

• Minimum GED or High School Diploma
• Minimum 2 years’ experience in a hospital or physician’s office working patient accounts or insurance workflows with strong customer service facing responsibilities.
• Working knowledge of medical billing and medical terminology
• Knowledge of Health Insurance Portability and Accountability Act (HIPAA)

Must be able to successfully pass a background check and drug screen to the satisfaction of the organization.

Essential Functions of the Position

• Account resolution duties, to include contacting payers or identified responsible parties for claim status & resolution.
• Monitoring and documentation of claim status, requesting necessary information, submitting appeals and accurate documentation of accounts.
• Post denials and take appropriate actions to achieve account resolution, including submitting appeals.
• Apply adjustments as needed based on correspondence received.
• Review and research credit balances for account resolution.
• Process correspondence related to patient accounts accurately.
• Appropriately document patient accounts to reflect all updated and necessary information, including updated demographic or payer information.
• Maintain set quality and quantity productivity standards.
• Understands revenue cycle key performance indicators and works to achieve the KPIs of the team.
• Maintain knowledge of current industry standards and organizational practices and work in a manner that supports a patient centered, team focused, and fiscally responsible organization.
• Communicate with other team members and leaders on identified trends and process improvement opportunities.

Punctuality and regular, predictable, reliable, consistent attendance is essential. Other essential functions include professionalism, the ability to communicate effectively (verbally and in writing), maintaining confidentiality, exercising sound judgment, being adaptable and flexible, following safety and compliance protocols, being accountable, complying with the Code of Conduct, organizational policies, procedures, practices, and expectations, and performing the core duties of the position either with or without a reasonable accommodation.

Other Functions of the Position

Performs other job-related duties, functions, tasks and responsibilities as assigned, which may vary based on evolving organizational needs and priorities. These responsibilities are not considered essential functions of the position and may be modified or reassigned to accommodate individuals with disabilities, in accordance with the Americans with Disabilities Act (ADA) as amended.

Knowledge, Skills, Abilities, and Other Characteristics

• Adherent to all organizational policies and work with the highest level of integrity.
• Adhere to and enforce all safety standards and organizational policies.
• Proficiency with Microsoft Office (Word, Outlook, Excel, and PowerPoint).
• Excellent time management skills with attention to detail.
• Ability to work independently and with a group and maintain good working relationships.
• Able to utilize complex math and reasoning skills for budgeting, analysis, and risk assessment.
• Ability to frequently utilize complex math and reasoning skills for budgeting, analysis, and risk assessment.

Supervisory Responsibilities

• This position does not have supervisory or management responsibilities of other employees.

Physical Demands

• This position requires a frequent amount of time at a stationary desk sitting for up to 8 hours daily with frequent repeating motions that may include wrists, hands, and fingers. Hearing and talking to interpret job functions are frequently required and frequent visual ability to judge distance and space and clarity up to 20 ft.
• There are minimal hand tool operation and minimal ascending or descending ladders, ramps, or stairs.
• Occasionally may need to lift pull or pull objects up to 25 lbs. in all directions with a maximum lifting of 50 lbs.
• There is occasional walking and standing but minimal kneeling, crouching, bending, twisting.

Work Environment

• The position works in a temperature-controlled environment with occasional exposure to extreme temperatures to include humidity.
• Sometimes may be exposed to fumes, grease, or oil and may experience minimal poor ventilation or air circulation.
• The noise level is frequently quiet with minimal exposure to moving mechanical parts/machines.