Responsibilities

The Payment Specialist is responsible for the accurate and timely import and processing of Electronic Remittance Advices (ERAs) and manual payment posting to PMS to meet team goals and objectives. Confirms Electronic Funds Transfer (EFT) and deposits (including lockbox) and processes payments following IPM CBO guidelines. Performs timely and accurate ERA reconciliation to include ERA processing, Process Level Adjustments (PLB) and credits applied to the PMS following the processing of an ERA file to minimize lag days. Meets or exceeds established performance targets (productivity and quality) established by the Payments Supervisor. Overlapping duties of posting, depositing and reconciliation of remits is strictly prohibited. Exercises good judgement in escalating identified payer specific ERAs that are not posting 100% to the Practice Management System (PMS) to maximize automated processing opportunities. Escalates payer EFT/deposits that are received without corresponding Explanation of Benefits (EOBs) or ERA file to maximize payer ERA enrollment. Demonstrates the ability to be an effective team player. Upholds “best practices” in day to day processes and work flow standardization to drive maximum efficiencies across the team.

Qualifications

Education: High School Graduate/GED required. Technical School/2 Years College/Associates Degree preferred.

Work experience: Experience 1-3 years minimum) working in a healthcare (professional) billing, health insurance or equivalent operations work environment.

Knowledge: Healthcare (professional) billing, knowledge of CPT/ICD-10 coding, claim submission requirements and remittance processing. Understanding of the revenue cycle and how the various components work together preferred.

Skills: Excellent organization skills, attention to detail, research and problem solving ability. Results oriented with a proven track record of accomplishing tasks within a high-performing team environment. Service-oriented/customer-centric. Strong computer literacy skills including proficiency in Microsoft Office.

Abilities:

Equipment Operated: Mainframe billing software (e.g., Cerner, Epic, IDX) experience highly desirable.