The Payment Resolution Analyst processes all out of network insurance claims to ensure appropriate payments are received, negotiates payments with payers, provides good faith estimates to potential patients and processes and follows up on independent dispute resolution appeals.
Reconciles billing and payment data on an automated system to maintain and update receivable status on out of network payments posted on the patients' account.
Communicates with third party payers by means of correspondence or by telephone to start payment negotiation on accounts that are deemed "underpaid" per set guidelines.
Reviews payments to assess if account will be sent for independent dispute resolution.
Prepares and submits appeals for independent dispute resolution.
Negotiates with third party payors on underpayments.
Works collaboratively with other departments to ensure accuracy of patient billing.
Responsible for maintaining and implementing new process/procedures based on regulatory updates.
Any other responsibility as directed.
Must have at least 1 year billing and follow up experience in a hospital environment or 3 years billing and follow up experience in a physician's office.
High school or equivalency diploma and combination of years of experience, college education or healthcare certification equivalent.
Licenses / Certifications:
Must possess strong organizational and communication skills, and Microsoft office aptitude (Word/Excel/Outlook. Must be comfortable with data entry utilizing multiple patient access programs and software. Work effectively in a multi task fast paced environment prioritizing and completing tasks in a timely manner. Problem solving skills and attention to detail to assess and resolve conflict in a timely manner. Proficient in oral and written communications.
WMCHealth is a 1,900-bed healthcare system headquartered in Valhalla, New York, with ten hospitals on eight campuses spanning 6,200 square miles of the Hudson Valley. WMCHealth employs more than 12,000 people and has nearly 3,000 attending physicians. From Level 1, Level 2 and Pediatric Trauma Centers, the region’s only acute care children’s hospital, an academic medical center, several community hospitals, dozens of specialized institutes and centers, a state of the art Telemedicine program, skilled nursing, assisted living facilities, homecare services and one of the largest mental health systems in New York State, today WMCHealth is the pre-eminent provider of integrated healthcare in the Hudson Valley.