Note: The job is a remote job and is open to candidates in USA. Yale New Haven Health is hiring an Account Resolution Analyst to manage third-party claims and resolve inpatient and outpatient account balances. The role supports timely and accurate claims submission, payment follow-up, and compliance with billing and payer requirements.
Responsibilities
- Handles a high volume of third party claims, ensuring accurate information is submitted to payers via clearing house and/or payer intermediary. Initiates actions necessary to correct problems that prevent claims submission or contacts individuals responsible for taking corrective action and documents all actions appropriately
- 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. Identifies and reports trends of claim edits and rejections to supervisor for further review
- 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. Documents all follow up activities on accounts in a clear and concise manner. Follow up activities are primarily performed via telephonic and web based methods of communication with all third party payers / self pay patients as well as internal communication with other hospital departments to facilitate payment of claims
- 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
- Maintains general knowledge of medical billing requirements, payer payment methodologies, and self pay billing guidelines. Keeps abreast of changes to federal, state, and insurance regulations
- Performs all other duties as requested including: 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
Skills
- High school diploma
- One (1) to two (2) years of third party claims management and/or billing experience in a computerized hospital/healthcare revenue cycle environment
- 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
- Proven ability to effectively navigate various payer websites and other web based applications
- Associate Degree in business related field
- Preferably Epic
- Microsoft Office skills
Benefits
- 100% remote
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