The Payment Resolution Analyst is responsible for processing all out of network insurance claims to ensure appropriate payments are received. This position negotiates payments with payers, provides good faith estimates to potential patients and processes and follows up on independent dispute resolution appeals. In addition, The Payment Resolution Analyst conducts network reimbursement analysis and communicates insufficient payments to internal and external departments.
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 negotiations 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 of negotiated settlements.
Works collaboratively with other departments to ensure accuracy of patient billing.
Maintains and implements new process/procedures based on regulatory updates.
Identifies trends in out of network underpayments.
Compiles and analyzes data to make recommendations and reports to management.
Works on multiple projects/initiatives and completes tasks in a timely manner.
Performs other duties as assigned.
QUALIFICATIONS / REQUIREMENTS:
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.
If applicable, the individual performing this job may reasonably anticipate coming into contact with human blood
and other potentially infectious materials. Individuals in this position are required to exercise universal precautions, use personal protective equipment and devices, and learn the policies concerning infection control.
Good Samaritan Hospital
Good Samaritan Hospital in Suffern, NY, is a 286-bed hospital providing emergency, medical, surgical, obstetrical/gynecological and acute-care services to residents of Rockland and southern Orange counties in New York; and northern Bergen County, NJ. The hospital is home to a recognized cardiovascular program, comprehensive cancer-treatment services, the area's leading Wound and Hyperbaric Institute and outstanding maternal/child services that includes a Children's Diagnostic Center. Good Samaritan Hospital also provides social, psychiatric and substance-abuse services and its certified home-care agency supports residents of the Hudson Valley and beyond.
Due to a recent upgrade in our online applicant tracking system, anyone who has previously applied for a position with Good Samaritan Hospital will be required to reapply.
With this recent upgrade to our system, all previous applications are no longer accessible by the WMCHealth Recruitment Team. We apologize for the inconvenience, and we appreciate your understanding during our efforts to upgrade our systems to be able to provide a better candidate experience.
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.