Billing, Payment Specialist

Department

Billing

Payment Specialist

Non-Exempt

Manager of Revenue Cycle Management

• Decisiveness
  - The ability to recognize key factors and finalize difficult decisions.
• Dependability
  - Fulfilling what I consented to do, even if it means unexpected sacrifice.
• Initiative – Recognizing and doing what needs to be done before I am asked to do it.
• Thoroughness – Knowing what factors will diminish the effectiveness of my work or words, if neglected.
• Flexibility – Willingness to change plans or ideas without getting upset.

The Payment Specialist is responsible for ensuring all payments are processed accurately in a timely manner, handling refund requests and analyzing explanation of benefits (EOBs) for errors in claims and payment processing.

• Retrieves electronic payments and EOB’s online and save to a designated location.
• Scans and posts insurance payments and adjustments of remittance advices received via paper or electronically into the Electronic Health Records (EHR) ensuring that the patient balance is correct.
• Posts patient payments and refunds into the EHR.
• Scans and posts EOB denials and refunds into the EHR and accurately apply to the patient’s account.
• Identifies and locates missing remittance advices by using payer websites and/or contacting the payers directly.
• Analyzes claims during the posting process to determine whether they were processed accurately. Notify a Claims Resolution Specialist if any issues are discovered based upon verification of benefits or missing information including pre-certs or claim errors.
• Tracks and reports ongoing issues and trends to the Manager of Revenue Cycle Management.
• Handles all refund requests from insurance, to include researching issues to determine if refunds are due, requesting payment from AP/processing through payer portal, and posting recoupments in the EHR.
• Follows standard operating procedures (SOP) protocols and established guidelines for each payor.
• Posts daily deposits on self-pay accounts and private pay accounts.
• Balances posted payments to the actual bank deposits on a monthly basis.
• Meets established daily, weekly, monthly and annual deadlines.
• Stays abreast of coding changes and updates to reimbursement guidelines per EOB explanations and inform Manager of Revenue Cycle Management of trends and changes.
• Manages and maintains relationships with all payors to improve patient revenue.
• Upholds Medicare, Medicaid, and HIPAA compliance guidelines in relation to billing, collections, and PHI information.
• Follows written and verbal instructions from the Manager of Revenue Cycle Management.
• Exhibits professionalism in communication with patients, clients, insurance companies and co-workers.
• Participates in special projects.
• Supports Variety Care’s accreditation as a Patient-Centered Medical Home and our commitment to provide care to all Variety patients that is Safe, Effective, Patient-Centered, Timely, Efficient, and Equitable. Provide leadership and work with all staff to achieve the goals of the “Triple Aim” of healthcare reform—to improve the experience of care, improve health outcomes, and decrease healthcare costs.
• Embodies the strength of personal character. Places value on being an open and honest communicator who displays high moral and ethical conduct, integrity, adaptability, and sound judgment. Must be a leader in the department and community. Result-oriented problem solver who is responsible and accountable.
• Performs other duties as assigned.

• High School diploma or GED. Associates degree highly preferred or equivalent combination of experience and education.
• Three years medical payment posting experience.
• Prior medical billing and insurance collections or healthcare revenue cycle experience including diversified experience with payers, managed care contracts, and payer methodology.
• Knowledge of CPT codes.
• Knowledge of medical terminology and protocols as well as basic knowledge of coding and anatomy are required.
• Expert critical thinking, analytics, problem-solving and sound decision-making skills.
• Experience interacting and communicating effectively with individuals at various levels both inside and outside the organization, often in sensitive situations.
• Experience using Microsoft Office and practice management software systems.
• Experience assisting and supporting others in a professional and respectful manner.

• Must be able to lift and/or move up to 25 pounds.
• While performing the duties of this job, the employee is frequently required to sit, stand, walk and talk.
• Frequently required to bend and reach to fulfill job duties.