Insurance Biller​/Systems Accounts Resolution Analyst

Position: Insurance Biller/Systems Accounts Resolution Analyst Full Time 40 hours

Overview

In a hospital and/or professional office environment, the Systems Account Resolution Analyst is responsible for billing and patient account reconciliation. This role requires critical thinking, organizational skills, account investigation, claim escalation, and overall account resolution of a patient and/or insurance balances. Tasks are accomplished through insurance web portals, call inquiries, written correspondence, and collaboration with internal departments. The role may be performed in a team environment or independently and contributes to departmental and organizational goals.

Responsibilities

• Contacts insurance carriers to facilitate payments, review underpayments and denials. Refer difficult accounts to denials team for further action
• Identify barriers to efficient departmental operations related to self-pay billing/trends in insurance denial and participate in developing solutions
• Actively work daily work queue and clearing house denials
• Assist the self-pay follow up team with processing financial assistance applications, payment plans through third party vendor, preparing patient refund requests, processing bankruptcy notifications, return mail, etc
• Review payer bulletins to stay current on updates
• Communicate with departments and Coding Vendor to resolve claim issues
• Respond to and take action on calls, emails, and faxes related to patient billing in a timely and professional manner
• Use a patient-centric approach to answer questions and provide information professionally
• Understand all payer regulations to effectively communicate with patients about charges, payments and adjustments on their account
• Investigate patient inquiries/disputes surrounding charging, coding, payments, locations, services, insurance coverage, etc
• Collaborate with individuals at various levels of the organization to find resolution on patient disputes
• Update account information (addresses, insurance, etc.) and rebill as appropriate to initiate next steps in the billing and collection cycle

Qualifications

• High School Diploma and at least three (3) years of revenue cycle experience which may include insurance and self-pay billing and collections, remittance processing, patient access and/or other revenue cycle areas in a hospital or physician office setting. Bachelor's Degree Preferred
• Effective communication with third parties (insurance payers, patients, internal departments, vendors, leadership, etc.) to relay updates on patient accounts in a timely manner
• Ability to read and write in English
• Ability to organize and articulate account disputes and written letters of appeal
• Excellent customer service, interpersonal, organizational and analytical skills
• Proficient in Office Applications (e.g., Excel, Word, Google Sheets, Google Mail)
• Comprehensive knowledge of Professional and/or Hospital revenue cycle
• Ability to work in a high-volume setting and respond to inquiries promptly
• Ability to identify and communicate payer trends and/or system trends
• Ability to navigate payer websites
• Knowledge of payer contracts, regulations and guidelines, and state and federal laws relating to billing, collection, and financial assistance procedures (preferred)
• Familiarity with medical and insurance terminology
• Proficient in the use of computer and hospital software applications e.g., Meditech and/or eClinical Works
• Understanding and adherence to HIPAA Regulations and Release of Information Rules
• Teamwork orientation and ability to collaborate within and outside the work group
• Ability to attain productivity and quality standards per department requirements

State/Federal Mandated Licensure Or Certification Requirements

• None.

Bristol Hospital Mandated Educational Requirements

• General orientation at time of hire. Fire/Safety/Infection Control annually. Other programs as mandated by Hospital.

Special Requirements

• Adapts at PC use – keyboard proficiency; physical requirements include sitting/standing, continual computer use, and data input

Work Environment

• Normal office conditions

Cognitive Requirements

• Ability to think independently, analyze information, follow directions, speak and write English, and have good mathematical aptitude

Disclaimer

The statements describe the general nature and level of work performed by people assigned to this classification and are not exhaustive. Duties may be added or reassigned as needed.

Employment type

• Full-time

Seniority level

• Entry level

Job function

• Accounting/Auditing and Finance

Industries

• Hospitals and Health Care

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