Resolution Analyst – Denials

• The Resolution Analyst acts as the liaison between key client contacts and our denials and underpayment appeal process to the appropriate payer.
• The Resolution Analyst is responsible for facilitating payment review recovery efforts for denied and underpaid accounts for assigned clients, thereby increasing the departments revenue.
• This position is responsible for handling patient health information (PHI) and maintaining extreme privacy and security as it relates to confidential and proprietary information.

Requirements

• High School Diploma or GED required. Associates or Bachelor’s Degree preferred.
• 5+ years’ experience in healthcare field working in billing or collections.
• 1+ years’ client facing/customer services experience.
• Intermediate level understanding of insurance payer/provider claims processing and subsequent data requirements.
• Equivalent combination of education and experience will be considered.
• Must have strong computer proficiency and understand how to use basic office applications, including MS Office (Word, Excel, and Outlook).
• Intermediate understanding of ICD, HCPCS/CPT coding, and medical terminology.
• Strong understanding of the revenue cycle process.
• Full understanding of hospital reimbursement, Intermediate knowledge of Managed Care contracts, Contract Language, and Federal and State requirements.
• Familiarity with HMO, PPO, IPA, and capitation terms and how these payors process claims.
• Intermediate understanding of EOB, hospital billing form requirements (UB04), and familiarity with the HCFA 1500 forms.
• Demonstrate strong ability to review client/payer contracts to identify complex underpayments.
• Regular and predictable attendance.

Core Competencies

Demonstrates expertise in healthcare billing and collections, with a strong understanding of the revenue cycle process and insurance claims processing. Proficient in handling patient health information while ensuring compliance with privacy and security standards.

Highest-signal resume keywords

• Healthcare Billing Experience
• Insurance Claims Processing
• Revenue Cycle Management
• ICD, HCPCS/CPT Coding
• Client Facing/Customer Service Experience

ATS Optimization Keywords

Hard Skills

• Healthcare Billing
• Claims Processing
• Revenue Cycle Management
• ICD Coding
• HCPCS Coding
• CPT Coding
• EOB Understanding
• Hospital Billing Forms
• Managed Care Contracts
• Data Requirements

Soft Skills

• Strong Communication
• Attention to Detail
• Problem Solving

Industry Keywords

• Patient Health Information
• Denials and Underpayment Appeals
• HMO
• PPO
• IPA
• Capitation
• Federal and State Requirements

Tools & Technologies

• MS Office
• Word
• Excel
• Outlook