Payment Resolution Analyst

Valhalla, New York, Job Summary: 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. Responsibilities: 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. Tracks outcomes. 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.

Qualifications/Requirements: Experience: 1 year billing and follow up experience in a hospital environment preferred Education: High school or equivalency diploma and combination of years of experience, college education or healthcare certification equivalent. Licenses / Certifications: Other: 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. About Us: NorthEast Provider Solutions Inc.

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