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Jacksonville, Florida
United States
Business Development
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Payment Resolution Specialist


Equal Opportunity Employer EOE M/F/D/V

Job ID 2017-21011
Employment Type full-time
Job Location US-NC-Winston-Salem
Hours Per Week 0.00


The Payment Resolution Specialist provides financial, administrative and clerical services to ensure accuracy and efficiency of operations. The Payment Resolution Specialist is responsible for processing and monitoring incoming payments and securing revenue by verifying and posting payments and Account follow-up and/or grievance preparation of assigned Client Hospital Accounts Receivable. Working at a Client site or in a Centralized location, responsibilities may include account maintenance of specialized or multiple payers including state and federal government programs, managed care, commercial and other insurance groups. The Payment Resolution Specialist may serve as a liaison to clinical auditors, other team members, hospital staff, government agencies and health plans to facilitate the appropriate and prompt payment of claims. This individual must demonstrate a commitment to the organization's strategic plans, short and long term goals and mission, vision and values by representing the company in a caring and professional manner


  • Approve all billable accounts in hospital and internal database by ensuring data entered is correct and update status correctly
  • Verify eligibility is accurate and program will cover services provided and is for correct dates of service
  • Review account to determine if account needs Authorization.
  • Verify that account balance and dates of service are accurate
  • Notifies client of approvals to initiate the billing process.
  • Enter payments into database and update database timely to reflect payments/adjustments
  • Assist in special projects as assigned by your leadership team member
  • Generates and formats reports for Client and Adreima.
  • Follow-up within appropriate time frames, contacts the health plan by phone or website to determine status of claim
  • Documents all follow-up actions in the hospital account notes, database and sets up account for additional review based on client expectations for follow-up of unresolved accounts
  • Researches all account information on paid or partially paid claims and analyzes the status of the payment related to the expected payment calculation and itemization provided by the remittance advice
  • Analyzes any denied, disallowed or non-covered claims and determines if non-payment is based on medical or technical reasons
  • Resolves any technical issues when warranted with health plans via phone or website
  • Prepares requests for account balance adjustments in accordance with client specific procedures
  • Prepares claims for clinical audit processing in the case of authorization, coding, level of care and/or length of stay denials
  • Follows guidelines for prioritization, timely filing deadlines, hospital and database documentation


  • Excellent communication skills, both verbal and written, with the ability to understand users' questions and effectively disseminate technical information are essential.
  • Minimum of 1 year with computer data entry, clerical and word processing experience.
  • Working knowledge of computer programs, i.e., Microsoft Excel®.
  • Must be able to type at least 30 wpm.
  • Ability to operate a multi-line telephone system.
  • Strong organizational and coordination abilities are required

Preferred Skills

  • Knowledge of Government eligibility program requirements is highly desirable.

About nThrive

nThrive is the leader in providing end-to-end revenue cycle services, technology and education solutions. Previously known as MedAssets, Precyse, Equation and Adreima, each formerly a leader in its own right, we've combined our talents and capabilities into a single enterprise. At nThrive, we are people who are passionate about empowering health care for every one in every community. We work together to transform financial and operational performance, enabling health care organizations to thrive.

nThrive is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, age, veteran status, disability, national origin, sex, sexual orientation, religion, gender identity or any other federal, state or local protected class.