Payer Account Resolution Specialist

Western Missouri Medical Center; Warrensburg (MO); On-site; USD 42,000 - 64,000; Full time

Job summary

Western Missouri Medical Center is seeking a Payer Account Resolution Specialist to ensure claims move from the clearinghouse to payers for adjudication. You will provide documentation to settle adjudications timely and monitor timely filing limits to support cash flow.

Responsibilities include monitoring aging >30 days, contacting payers, and coordinating claim corrections with other departments. The role demands attention to detail, strong organization, and reliable communication with payers.

Qualifications

• High school diploma or equivalent.
• 2+ years of healthcare billing or revenue cycle experience.
• Residency in Missouri or Kansas is required.
• Experience with MEDITECH EHR preferred.
• Understanding of CPT, HCPCS, ICD-10 coding and explanations of benefits.
• Attention to detail and accuracy; ability to meet deadlines.
• Strong communication and teamwork.

Responsibilities

• Monitor aging buckets >30 days in which claims have been transmitted and not adjudicated.
• Contact insurance companies via payer portal, payer chat or phone.
• Monitor timely filing limits.
• Document all account activities.
• Locate missing remits and/or payments.
• Resolve payer issues and coordinate necessary claim corrections.
• Submit requested documentation.
• Coordinate claim corrections with appropriate departments.
• Escalate complex issues as needed.
• Identify opportunities for process improvement.
• Research unpaid claims and report trends to leadership.

Skills

Attention to detail

Effective communication

Teamwork

Time management

Organizational skills

Education

High school diploma or equivalent

Job description

Description

Purpose Statement

The Payer Account Resolution Specialist is responsible for ensuring claims have successfully transferred from the clearing house to the payer for adjudication. Provide any documentation as requested from payers in order to complete adjudication timely. Closely paying attention to timely file requirements. The Payer Account Resolution Specialist ensures claims are being received and adjudicated by payers within their timely filing limit, forming the foundation of the revenue cycle. This directly impacts cash flow, reduces delays, Timely File Adjustments and supports overall financial performance.

Essential Functions

• Monitor aging buckets >30 in which claims have been transmitted and have not been adjudicated.
• Contact insurance companies via payer portal, payer chat or phone calls.
• Monitor timely filing limits.
• Document all account activities.
• Locate missing remits and/or payments.
• Resolve payer issue.
• Submit requested documentation.
• Coordinate any claim corrections needed with appropriate department.
• Escalate complex issues.
• Update any identified registration errors.
• Identify opportunities for process improvement.
• Research unpaid claims.
• Communicate with leadership any trends that have been identified.

Requirements

Education / Experience / Skill Requirements

• High school diploma or equivalent.
• 2+ years of healthcare billing or revenue cycle experience.
• Current residency in Missouri or Kansas is required.
• Experience working in an EHR system (MEDITECH preferred).
• Basic understanding of:
• CPT, HCPCS, and ICD-10 coding.
• Insurance billing processes.
• Understanding of Explanation of Benefits.
• Attention to detail and accuracy.
• Time management and ability to meet deadlines.
• Strong organizational skills.
• Effective communication and teamwork.
• Ability to follow standardized workflows.

Performance Metrics

• Keeping AR Days under 40 days.
• Cash meeting or exceeding organization goal.
• Keeping AR under 90 less than 25%.
• Maintain regular and predictable attendance.
• Perform other essential duties as assigned.

Physical / Mental Requirements

• Must be able to sit and stand, intermittent 8 to 10 hours a day.
• Must be able to use standard office equipment, including the telephone and computer keyboard.
• Continuously works under pressure of near 100% accuracy while meeting inflexible deadlines.
• Continuously utilizes manual/bi-manual dexterity, near vision, speech, and hearing.
• Frequently stands, walks, sits and utilizes eye/hand coordination and color definition.
• Occasionally reaches above shoulder, regularly required to lift and/or carry up to 40 lbs.
• Occasionally walks on uneven surfaces.