Account Resolution Specialist

We are seeking an Account Resolution Specialist, sometimes referred to as a Managed Care Follow-Up Specialist or Commercial Account Follow-Up Specialist. The Account Resolution Specialist is responsible for the timely follow-up and resolution of Managed Care and Commercial accounts, ensuring accurate reimbursement and compliance with payer and state collection guidelines. This role communicates clearly and professionally with health plans by phone, reviews managed care contracts and maintains required productivity standards and reporting. 

Shifts Available: Days  

Employment Type: Full-time 

Hours: 8-hour shift  

Location: St Joseph Medical Center – Kansas City, MO 

Here are some of the benefits of working at Prime Healthcare: 

• Health, dental, and vision insurance options 

• Paid vacation, sick time and holidays 

• Bereavement leave, FMLA and other leave options 

• Employer 401K options 

• Tuition reimbursement options  

• Life, disability, and other insurance options 

• Many other amazing benefits 

Essential Duties and Responsibilities (includes, but not limited to): 

• Perform timely follow-up on Managed Care and Commercial accounts to support accurate reimbursement and account resolution 

• Communicate clearly and efficiently with health plans by phone regarding account status, payment issues, and follow-up needs 

• Review managed care contracts to ensure reimbursement aligns with contractual terms and requirements 

• Obtain and apply state collection guidelines, when applicable, to support compliant account resolution practices 

• Maintain productivity standards and complete required reports accurately and on time 

Education and Work Experience

1. Minimum of four years hospital managed care/commercial collector experience required.
2. Bachelor's degree or equivalent work experience preferred.
3. Knowledge of contract interpretation.
4. Familiar with hospital billing requirements

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