Billing Specialist

Job Summary:

The Payment Application Specialist is responsible for researching, auditing, reconciling, and applying all cash receipts to accounts receivable. This role involves interpreting explanations of benefits, reconciling payments, identifying external and non-patient payments, and resolving balancing issues. The specialist also identifies issues with electronic remittance advice, contractual calculations, and payer compliance, escalating them as necessary.

Location:

San Diego, California, United States

Responsibilities:

- Researches, audits, and reconciles payments for various departments.
- Interprets explanations of benefits (EOBs) and reconciles and applies payments, recoupments, and provider level adjustments (PLBs).
- Identifies external payments and non-patient payments, transferring them to the appropriate entity/general ledger account using designated adjustment codes.
- Processes payments and denials with the correct denial/remittance codes, applying them to the appropriate account/liability bucket.
- Handles processing of Non-Sufficient Funds (NSF) payments.
- Conducts in-depth research to resolve balancing issues or reconcile unidentified payments posted to clearing accounts.
- Identifies issues with ERAs/contractual calculations/payer compliance and escalates appropriately.
- Uses system-generated reports and performs in-depth research and reconciliation of variances in the internal balancing tool.
- Recognizes and shares areas for process improvements.
- Trains team members, documents processes, and participates in workflow testing and other projects.
- Performs other duties as assigned.

Required Skills &

Certifications:

- High school diploma or GED equivalent.
- Minimum of 2 years of experience in payment application.

Preferred Skills &

Certifications:

- 5 years of experience in payment application.

- Experience with Brightree system or relatable homecare payment posting experience.

- Experience with commercial payors.

Special Considerations:

- None specified.

Scheduling:
- Not specified.