Payer Claims 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

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.