Account Resolution Specialist

LifePoint Health; Louisville (KY); On-site; USD 40,000 - 55,000; Full time

Job summary

A leading healthcare organization is seeking an Account Resolution Specialist to manage accounts receivable resolution. The role involves researching claims, resolving issues with insurance payers, and processing appeals. Ideal candidates will have strong problem-solving skills and experience in healthcare collections.

Qualifications

• Minimum of 2 years in healthcare collections.

Responsibilities

• Support A/R resolution by researching claims and working with insurance payers.
• Initiate collection follow-up of unpaid or denied claims.
• Develop and submit detailed appeals to payers.

Skills

Research

Communication

Problem Solving

Detail-oriented

Education

High School Diploma

Job description

At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates.

Job Summary

• The Account Resolution Specialist will be responsible for supporting A/R resolution in our Central Business Office by effectively and efficiently researching claims and taking action with the insurance payers to achieve timely account adjudication.
• The ideal candidate has the ability to recognize and solve issues as appropriate, interpret contract terms to ensure accounts receivables are properly stated, in addition to writing and processing underpayment technical appeals.
• Review unpaid claims, research reasons for delay, and work with payers to resolve the issues.
• Initiate collection follow-up of unpaid or denied claims.
• Effectively follow up on appeals and resolve claim rejections, underpayments, and denials.
• Research technical payer denials related to referral, pre-authorization, non-covered services, and billing resulting in denials and delays in payment; initiate appeals with insurers appropriately.
• Develop and submit detailed, customized appeals to payers based on review of denial, applicable records, and in accordance with payer guidelines as well as Kindred’s policies and procedures.
• Review outstanding accounts and aging reports.
• Process adjustments when required.
• Responsible for statusing A/R effectively.
• Respond to insurance company requests for additional documentation in a timely manner.
• Communicate pertinent information to Business Office Director.
• Track trending issues.
• Work with multiple systems daily.
• Review EOBs to identify payment errors, denials, and low reimbursement.
• Make regular follow-up calls to insurance companies regarding claims.
• Research account receivables for both Medicare and Non-Medicare collections.
• Conduct thorough account research and analysis.
• Recognize, reconcile, and resolve account discrepancies.
• Provide timely updates on actions taken on patient accounts; process refunds to insurance carriers or patients; correct late charges; monitor insurance coding and effective/exhaust dates.
• Identify net revenue hits and pickups.
• Perform underpayment variance reviews.
• Identify, log, and work denials effectively.
• Read and monitor insurance contracts to ensure claims are managed accordingly.

Knowledge/Skills/Abilities

• Research, analyze, and resolve problems effectively.
• Multi-task efficiently.
• Excellent verbal and written communication skills.
• Use independent judgment to recognize and resolve issues.
• Work independently with initiative.
• Manage multiple tasks and shift priorities positively.
• Strong sense of ownership and accountability as a team player.
• Detail-oriented, organized, and motivated.

Qualifications

Education

• High School Diploma or equivalent.

Experience

• Minimum of 2 years in healthcare collections.