Payment Resolution Director - Payer Specialization

HCA   •  

Nashville, TN

Industry: Healthcare IT


8 - 10 years

Posted 344 days ago

Parallon believes that organizations that continuously learn and improve will thrive. That’s why, after more than a decade, Parallon remains dedicated to helping hospitals and hospital systems operate knowledgeably, intelligently, effectively and efficiently in the rapidly evolving healthcare marketplace, today and in the future. As one of the healthcare industry’s leading providers of business and operational services, Parallon is uniquely equipped to provide a broad spectrum of customized revenue cycle services.
This position is responsible for assisting in the development, evolution and implementation of the overall Payer Specialization strategy in the critical area of Payment Compliance. Initial focus will be on Aetna and United and will include objectives such as using a data driven focus to evaluate, recommend and champion implementation on Payment Resolution functions. The Payment Resolution Director is responsible for overseeing the remittance advice discrepancy function, which includes the collection of disputed underpayments and the processing of refunds of overpayments. This individual is responsible for consistent application of all standard A/R and Accounting processes, and for accurate and timely discount and allowance calculations, analyses and reconciliations of accounts receivable related to discrepancy payments and denials. As part of this role, this individual must demonstrate strong commitment to stakeholder relationships by taking ownership of issues and facilitating effective outcomes in a timely manner.
Supervisor - AVP Payer SpecializationSupervises - Overpayment and Underpayment Resolution Teams

Duties (included but not limited to):


  • OverseetheactivitiesandmanagementrelatedtoPayment Compliance discrepancy inventory,ensuringprocessesareperformedefficiently, effectively and accurately.
  • Establishcontrolsandreviewmechanismsfor SSCpoliciesandprocedures.
  • Ensure timely submission of reconsiderations, payer packages and liquidation of discrepancy inventory.
  • Monitor,trendandcommunicatewithSSC, facility and corporate leadership,regardingtrends,newinventory fluctuationsand outstanding inventory identifiedvia EDW,Vista,andotherdenialstoolsreports.
  • Demonstratestrongcommitmenttostakeholderrelationshipsbytaking ownershipofissuesandfacilitatingeffectiveoutcomesinatimelymanner.
  • Understandandcommunicatecontractspecificissuesrelatedtotheresolutionofdisputedpayments,discountandallowancecalculationsforavarietyofpayerssuchasMedicare,Medicaid,HMOs,PPOs,IPAs,employers,etc.
  • Overseemanagementofpersonnel,providingrecommendationsforhiring,promotion,salaryadjustmentandpersonnelactionwhereappropriate.
  • Follow escalation protocols to include Attorney, Corporate Dispute Resolution and Corporate Payment Compliance.
  • Participate in Joint Operating Committees (JOC) with payers, ensuring partnership in inventory resolution.
  • Oversee all reconciliation activities for inventory.
  • Proactively ensure training of all employees, including identification and communication of any operational gaps identified in day to day activities.
  • Identifyandimplementprocessimprovementstolowerbillingcostsandimproveservicesto facilitycustomers.
  • Practiceandadhere tothe“Code ofConduct”philosophy and“Missionand Value Statement”.
  • Other duties asassigned.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 



  • Technical Expertise – Some understanding of healthcare including knowledge of healthcare terms and accounts receivable processes
  • Strategic Analysis - Analytical Review skills and ability to make decisions based on analysis
  • Leadership - guides individuals and groups toward desired outcomes, setting high performance standards and delivering leading quality services
  • Tactical execution - oversees the development, deployment and direction of complex programs and processes
  • Financial management - applies tools and processes to successfully manage to budget
  • Project Management - assesses work activities and allocates resources appropriately
  • Organization - proactively prioritizes needs and effectively manages resources
  • Communication - communicates clearly and concisely, verbally and in writing.  This includes utilizing proper punctuation, correct spelling and the ability to transcribe accurately. The ability to communicate with staff, Parallon Management, Division and Group Executives
  • Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations
  • Interpersonal skills - able to work effectively with other employees, patients and external parties
  • PC skills - demonstrates proficiency in Microsoft Office applications and others as required
  • Policies & Procedures - demonstrates knowledge and understanding of organizational policies, procedures and systems
  • Basic Skills – demonstrates ability to organize, perform and track multiple tasks accurately in short timeframes, have ability to work quickly and accurately in a fast-paced environment while managing multiple demands, ability to work both independently and collaboratively as a team player, adaptability, analytical and problem solving ability and attention to detail and able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly. Spell correctly and transcribe accurately.


  • Bachelor’sDegree in Business or related field required.  If a desired applicant does not have a Bachelor's Degree, the requirement can be waived IF they are currently in a Bachelor Degree program.  


  • Minimum7 years' healthcare management experience with three of these years in the related area for the position.  Relevant education may substitute experience requirement with SSC Executive approval.



  • CPA highlypreferred

Job Code: 26875-137839