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.
The Accounts Receivable Analyst handles a high volume of third party claims and ensures that accurate information is submitted to payers via the clearing house and/or payer intermediary in a timely manner to ensure prompt payment. Initiates the actions necessary to correct problems that prevent claims submission and/or contacts the individuals that are responsible for taking the corrective action to expedite claims processing.
Documents all follow up activities on accounts in a clear and concise manner. Identifies and reports the trends of claim edits, denials and rejections to the supervisor for further review. Performs a variety of duties necessary to resolve individual patient balances.
Keeps abreast of the changes to federal, state, and insurance regulations as well as maintains a general knowledge of billing and payment methodologies/guidelines. Has an understanding of the Professional Billing Revenue Cycle and how it functions. Performs all other duties as requested by supervisor.
1.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. 2. 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, denials and rejections to supervisor for further review. 3. 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 departments to facilitate payment of claims. 4. Performs a variety of duties necessary to resolve individual credit balances based on departmental procedure. Posts adjustments to maintain the integrity of the account as required. 5. 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. 6. Analyzes transactions and identifies variances using payment variance software, payer websites and other online tools. Works with payer contracting, departmental staff, software vendors and third party payers to determine the root cause of payment variances and takes the appropriate actions to resolve. 7. 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.
High school diploma or GED required. Associate Degree in business related field preferred.
Minimum of one (1) to two (2) years' experience in healthcare revenue cycle with third party claims management and/or billing required.
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.
Responsible for the retrospective review of the payment of claims to ensure maximum reimbursement. Reviews remittance data to ensure that assigned claims reflect accurate information and have been submitted to payers through appropriate intermediary.
Responsible for reporting identified credit balances when appropriate. Must develop and maintain effective relationships with payer representatives to ensure accurate reimbursement according to a variety of contracts. Supports departmental goals and objectives by meeting or exceeding best practice standards. Ability to exercise sound judgment and act with discretion in a variety of situations as well as ensuring and maintaining sensitive information in a confidential manner, in accordance with HIPAA guidelines.
Highly organized individual with the ability to analyze data, problems, and exercise sound judgment. Uses sound and thoughtful problem solving skills to resolve account discrepancies and ensures timely collection of balances.
Capable of using analytical skills and resourcefulness to accomplish many tasks and balances multiple priorities in a fast paced environment. Ability to interact professionally (through written or verbal communication) with other departments, third party payers, and other agencies to resolve complex issues related to maximizing reimbursement.
Yale-New Haven Health