[Hiring] Account Resolution Analyst @Yale New Haven Health

Role Description

To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.

• Handles a high volume of third party claims and ensures accurate information is submitted to payers via the clearing house and/or payer intermediary in a timely manner.
• Initiates actions necessary to correct problems that prevent claims submission and contacts responsible individuals to expedite claims processing.
• Documents all follow-up activities on accounts in a clear and concise manner.
• Identifies and reports trends of claim edits and rejections to the supervisor for further review.
• Performs a variety of duties necessary to resolve individual inpatient and outpatient balances.
• Keeps abreast of changes to federal, state, and insurance regulations and maintains a general knowledge of billing and payment methodologies/guidelines.
• Has an understanding of the Revenue Cycle and how it functions.
• Performs all other duties as requested by supervisor.

Qualifications

• High school diploma required; Associate Degree in business related field preferred.
• One (1) to two (2) years of third party claims management and/or billing experience in a computerized hospital/healthcare revenue cycle environment, preferably Epic.
• Extensive knowledge of third party insurance carriers and their billing and reimbursement requirements.
• Excellent analytical and organizational skills.
• Demonstrated ability to perform detailed analysis quickly and accurately in a high volume, fast paced environment.
• Ability to communicate effectively both written and verbally.
• Microsoft Office skills preferred.
• Proven ability to effectively navigate various payer websites and other web based applications.

Requirements

• Completes daily claims submission within timeframe designated by supervisor.
• Resubmits claims via clearing house or payer intermediary with updated or corrected information based on departmental request.
• Resolves all clearing house rejections from third party payers on a daily basis.
• Follows up on a high volume of paid and unpaid claims to expedite prompt and accurate payment based on established department workflows.
• Determines the reason for nonpayment and takes appropriate follow up action to ensure resolution.
• Follow up activities are primarily performed via telephonic and web based methods of communication with all third party payers/self pay patients.
• Performs a variety of duties necessary to resolve individual inpatient and outpatient credit balances based on departmental procedure.
• Posts adjustments to maintain the integrity of the account as required.
• Keeps abreast of changes to federal, state, and insurance regulations.
• Identifies problem and delinquent accounts after exhausting all avenues of collections and advises Supervisor of the need for intervention.
• Recognizes problem areas and trends that impact account resolution and makes suggestions for improvements.
• Actively participates in staff meetings, seminars, training sessions, and workgroups to advance departmental goals.

Company Description