Job Description

MAJOR PURPOSE OF POSITION:

The Payment Posting Specialist is responsible for taking proactive action to research claims, correct denials and prepare thorough documentation of cases as well as responsible for the accurate and timely posting of payments (live checks, credit cards, EFT's, refunds (insurance and/or patient), ensuring receipt of remittance advice for each daily deposit, scanning and uploading remittance to patient accounts, as well as special projects.

PRIMARY DUTIES & RESPONSIBILITIES:

● Conduct AR follow-up both on front end scrubs and back end denials through best practices.

● Review and clear claim edits and rejections in the system.

● Responsible for processing payments for insurance companies and patients for their assigned regions either electronically or manually.

● Responsible for posting payment batches including denials within established timeframe and balancing the batches against daily deposits.

● Demonstrate a detailed understanding of how to read and interpret EOB's and denials from all insurance carriers (including the financial components such as co-pays, deductibles, and co-insurance).

● Differentiate between best practices of appeal, coding review, credentialing review and/or adjustment.

● Contact insurance companies and utilize web portals and websites for payment information.

● Ability to audit insurance information for appropriateness in current billing system and can quickly identify underpayments or other trends that may negatively affect cash flows.

● Must report and communicate issues and trends to managers and leadership on a timely basis.

● Provide excellent customer service through answering of patient phone call line in a timely basis and provide thorough review of patient accounts.

● Possess a thorough knowledge of appeals processing from end to end across all payer categories based on insurance denials.

● All other assigned duties as delegated by supervisor(s).

● Meet or exceed daily productivity benchmarks.

EDUCATION/EXPERIENCE REQUIREMENTS:

● 2+ years of experience in claims resolution or medical billing.

● Formal certification in medical billing and coding or have equivalent experience.

SPECIFIC KNOWLEDGE/ TECHNICAL SKILLS REQUIREMENTS:

● Working knowledge of CPT, ICD-10, and medical terminology.

● Knowledge of basic math and the ability to perform math functions.

● Knowledge of coordination of benefits requirements and processes.

● Knowledge of cash posting regulations and guidelines.

● Knowledge of insurance rejection/denial processing and appropriately posts information for collection and follow-up activity.

● Ability to work well in a team environment and be flexible in a problem solving environment.

● Excellent communications skills.

● Excellent EMR systems experience and acuity.

● Proficiency in Microsoft Office Suite, including Word and Excel.

SOFT SKILLS REQUIREMENTS

● Ability to provide, receive and incorporate constructive feedback.

● Excellent interpersonal and professional communication skills.

● Acute attention to detail and critical thinking skills.

● Ability to work effectively under pressure related to deadlines or high volumes of work.

● Ability to switch between tasks effectively without compromising product quality.