Healthcare Remittance Processing Specialist

Description

This is an onsite position in Edmond, Oklahoma.

We are seeking an organized, detail-oriented, and results-driven Healthcare Remittance Processing Specialist to join our growing team. This individual will play a critical role in ensuring the accuracy and integrity of payment posting and reconciliation processes across multiple payor sources. The ideal candidate will have extensive experience in healthcare billing and reimbursement, a deep understanding of electronic remittance advice (ERA) data, and a proven ability to interpret complex payor methodologies.

This position supports the company’s technology-driven payment processing platform, ensuring that data extracted from healthcare payments is correctly balanced with appropriate CARC/RARC codes to produce compliant and accurate 835 electronic remittance files.

Key Responsibilities

• Payment Analysis & Posting

  • Review and analyze payments, adjustments, and denials from government, commercial, dental, and workers’ compensation payors.

  • Validate remittance accuracy, ensuring all payments and contractual adjustments align with payer rules and internal posting guidelines.

  • Apply correct CARC (Claim Adjustment Reason Codes) and RARC (Remittance Advice Remark Codes) to ensure a balanced and accurate 835 output.

• Remittance Interpretation & Support

  • Interpret insurance Explanation of Benefits (EOBs) and remittance advice statements to determine proper payment applications and adjustment codes.

  • Provide subject matter expertise and guidance to internal teams on interpreting payer remittance data and resolving discrepancies.

  • Troubleshoot and resolve complex remittance issues in coordination with payor representatives, billing teams, and data analysts.

• Process Development & Standardization

  • Review, document, and refine payment posting guidelines and standard operating procedures (SOPs) to enhance consistency and efficiency across the department.

  • Identify process improvement opportunities and contribute to the development of technology solutions that automate and streamline remittance processing.

  • Collaborate with data and product teams to enhance automated payment posting accuracy and minimize manual interventions.

• Collaboration & Communication

  • Work closely with supervisors, co-workers, and clients to ensure smooth workflow and adherence to established deadlines.

  • Communicate findings and recommendations clearly to leadership and cross-functional partners.

  • Participate in team meetings and training initiatives to support department goals and quality improvement efforts.

• Compliance & Quality Assurance

  • Maintain compliance with HIPAA and all applicable federal and state regulations related to healthcare payments and patient data privacy.

  • Ensure that all posted transactions and reconciliations meet internal audit standards and payer requirements.

  • Conduct periodic reviews to confirm accuracy and integrity of remittance data within the system.

Qualifications

• Education:

  • High School Diploma or GED required.

  • Associate’s or Bachelor’s degree in Healthcare Administration, Accounting, or related field preferred.

• Experience:

  • Minimum of 5 years of experience in medical billing, insurance collections, or healthcare revenue cycle operations.

  • In-depth understanding of payer methodologies, managed care contracts, and reimbursement practices.

  • Proven experience working with healthcare billing systems, clearinghouses, and 835/837 file structures.

• Skills & Knowledge:

  • Expert knowledge of CPT, HCPCS, and ICD-10 coding principles.

  • Proficiency in interpreting CARC/RARC codes and payer adjustment logic.

  • Strong analytical and problem-solving skills with attention to detail and accuracy.

  • Ability to manage multiple priorities in a fast-paced environment while maintaining high-quality standards.

  • Proficiency with Microsoft Excel and other data analysis tools.

  • Excellent written and verbal communication skills.