Payment Resolution Specialist

Job Summary

The Payment Resolution Specialist is responsible for ensuring accurate and timely management of account approvals and payment processing for Client programs. This role involves verifying patient eligibility, updating insurance information, and coordinating authorizations as needed to support efficient billing and collections. The specialist closely monitors account progression and payment activity, ensuring data accuracy across systems. By identifying and addressing issues proactively, they help maintain compliance, protect patient information, and support effective revenue cycle operations.

Duties & Responsibilities

• Verify patient eligibility, billing, and claim information across various systems
• Review and update patient demographics, insurance details, and coverage in Client systems
• Review accounts for authorization and forward to the Clinical team for review
• Prepare and send approval, exception, or denial reports to Clients
• Track account progression and update internal systems accordingly
• Follow guidelines for prioritization, timely filing, and notation protocols
• Monitor payments in Client systems for accurate invoicing
• Identify and escalate payer, system, or account issues as needed
• Maintain confidentiality and follow guidelines on prioritization, timeliness, and documentation
• Participate in meetings, training, and client interactions to ensure accurate billing and collections
• Complete special projects as required
• Adhere to and maintain strict confidentiality of patient information in accordance with insurance collection guidelines, HIPAA, corporate policy, and procedure, etc.

Qualifications & Competencies

• High School Diploma or GED
• Strong organizational and time management skills
• Experience managing priorities, multiple systems, and performance metrics
• Proficient in Medicare, Managed Care, and Commercial Insurances
• Advanced MS Office skills, especially Excel
• Excellent communication, interpersonal, and problem-solving abilities

Preferred Qualifications

• Experience with Federal/State programs (Social Security, Medicaid, Charity Care, etc.)
• Experience utilizing EPIC, Cerner, or Meditech systems

Pay

The salary range for this role is from $20.00 to $22.00. Specific compensation for the role will vary within the above range based on many factors including but not limited to geographic location, candidate experience, applicable certifications, and skills.