Western Missouri Medical Center

Account Specialist

• Ensure claims successfully transfer from the clearing house to the payer for adjudication
• Provide documentation requested by payers to complete adjudication timely
• Monitor aging buckets over 30 days for transmitted but unadjudicated claims
• Contact insurance companies through payer portals, payer chat, or phone
• Monitor timely filing limits
• Document all account activities
• Locate missing remits and/or payments
• Resolve payer issues
• Submit requested documentation
• Coordinate claim corrections with the appropriate department
• Escalate complex issues
• Update identified registration errors
• Identify process improvement opportunities
• Research unpaid claims
• Communicate identified trends to leadership
• Keep AR Days under 40 days
• Meet or exceed the organization’s cash goal
• Keep AR over 90 days below 25%
• Perform other essential duties as assigned

Payer Account Resolution Specialist

Billing Specialist

• Participate in Billing Department activities as a working manager.
• Supervise staff responsible for billing and collecting patient accounts.
• Manage daily operations and ensure accurate, cost-effective department performance.
• Maximize cash, minimize denials, prevent excessive receivables aging, and develop staff.
• Provide leadership and oversight to billing representatives and monitor productivity, quality, and account aging.
• Develop Meditech-related policies and procedures with the Director of Patient Financial Services.
• Monitor personnel functions and ensure compliance with hospital and departmental policies.
• Ensure accurate and timely claim submission, payment posting, follow-up, and outstanding-account resolution.
• Coordinate with hospital departments to maintain effective accounts receivable operations.
• Build relationships with payor representatives and facilitate appeals and policy interpretation.
• Train, develop, motivate, and support subordinates.
• Identify payer issues and denial trends and develop measurable resolution plans.
• Monitor staff schedules and attendance.
• Evaluate revenue-cycle performance using KPI, productivity, and quality measures.
• Attend meetings, training sessions, conference calls, team meetings, and one-on-one meetings with the Director of Patient Financial Services.
• Interview, hire, train, assign, direct, appraise, reward, and discipline employees; address complaints and resolve problems with the Controller.
• Maintain regular and predictable attendance.
• Perform other essential duties as assigned.

Payer Account Resolution Specialist

Billing Manager