Summary/Objective

The Revenue Resolution Specialist I is responsible for accurately posting insurance and patient payments, performing routine reconciliation tasks, and resolving basic payment discrepancies. This role supports the daily operations of the payment posting and refund team within the Patient Financial Services department and collaborates closely with senior staff to ensure the timely and compliant resolution of accounts. The Specialist applies critical thinking and developing Epic knowledge to maintain data accuracy that supports the organization's revenue cycle performance.

Essential Functions

• Posts insurance and patient payments, adjustments, and refunds into Epic, ensuring accuracy and timeliness in accordance with payer rules and department standards.
• Reviews daily lockbox deposits and retrieves corresponding Explanation of Benefits (EOBs) from Truist for accurate posting.
• Locates missing remittance data and payment information as needed to complete the posting process, using the Experian Claim Source tool.
• Conducts basic account research to resolve misapplied or missing payments and escalates more complex issues to senior staff or leadership.
• Verifies accuracy of payment amounts, adjustments, and patient responsibility by reviewing remittance data and referencing payer guidelines.
• Monitors assigned Epic work queues to address denial or exception postings and follows up on aged or incomplete claims.
• DocuMents posting actions and resolution efforts clearly and accurately within Epic and related systems.
• Supports accurate charge and refund posting workflows in collaboration with internal departments and under the direction of senior staff.
• Participates in cross-training, department meetings, and ongoing education to expand knowledge of Epic workflows, payer requirements, and revenue cycle best practices.
• Maintains confidentiality of patient and financial information in compliance with HIPAA and organizational policies.

High school graduate. An ability to assess complex situations where multiple options are available and decide upon the best course of action. 

Additional Eligibility Qualifications

Excellent organizational and critical thinking skills. Aptitude to retain detailed information. Ability to prioritize and be able to produce an acceptable volume of work. Must have a mathematical aptitude and an ability to concentrate on details is necessary. Ability to assess a situation and decide the best course of action. Excellent communication skills, oral and written. Be able to communicate ideas in a clear and concise manner. Use inter-personal skills effectively to communicate with internal and external customers to resolve payment issues. Basic knowledge of Windows based computer applications. Be able to operate the following equipment: computer, copier, fax, and 10-key calculator. Professional appearance and manner.