MEDICAL BILLING & PAYMENT SPECIALIST

Definition and Role

Under the direction of the Assistant Director of Revenue Cycle – Revenue Recovery, the Medical Billing and Payment Specialist, is responsible for accurately and timely posting of insurance payments, related contractual adjustments, and denials through electronic remit stations and/or manual posting methods. 

Job Responsibilities and Duties

• Capable of posting miscellaneous payments, manual and electronic to patient accounts, through EFT (Electronic Funds Transfer), ERA (Electronic Remittance Advice), and any other payment methods utilized by the practice.
• Export all 835 electronic payment files in preparation for posting.
• Resolve any edits and report issues timely and accurately from all 835 payer files.
• Post all non-EDI payments, contractual allowances, rejection codes, deductibles, and copayments.
• Obtain missing ERA/835/EOB from payers via portal or telephone.
• Research unidentified payments and/or recoupments to determine appropriate resolution for proper posting.
• Posts payments to practice management system (live checks within 24 hours, Online Credit Card payments the next business day, EFT deposits within 72 hours)
• Records batch totals with date and initials on payment receipt spreadsheet
• Balances batches and runs transaction reports.
• Verifies all EFT deposits and scanned checks have been posted by month end.
• Identify credit balances at time of posting and correct any erroneous mistakes.
• Maintains or exceeds established productivity goals and quality standards.
• Accepts payments and process current patient billing statements if needed.
• Update all spreadsheets with accurate information and run daily posting reports for balancing.
• Performs all other duties as assigned.

Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. While performing this job the employee is frequently required to sit, talk, and hear.
2. The employee is occasionally required to walk, use hands and fingers to feel, handle, or operate objects, tools, or controls, and reach with hands and arms.
3. The employee must occasionally lift and/or move objects weighing up to 25 pounds.
4. Specific vision abilities required by this job include close vision and the ability to adjust and focus.
5. Emotional/Psychological: Constant ability to make decisions and concentrate.

Qualifications

• A minimum of a High School Diploma preferred and two years of Medical Billing and Collection experience.
• Working knowledge of EOB’s, EFT’s, and ERA’s
• Knowledge of managed care contracts, Medicare, Medicaid, workers comp, and private insurance carriers
• Excellent attention to detail
• Proficient use of Microsoft Office applications (Word, Excel, Outlook)
• Outstanding interpersonal skills and great team player.
• Must be able to work independently with a high degree of self-initiative.
• Excellent problem-solving abilities.
• Ability to work well under pressure and adapt to changes in project priorities.
• Demonstrated understanding of medical terminology required.
• Knowledge of patient confidentiality and HIPAA regulations
• Knowledge of CPT, HCPCS, and ICD10 coding required.
• Knowledge of medical billing and collection practices
• Knowledge working with electronic health records (EHR/EMR) or healthcare related computer systems.
• Practices efficient methods for getting work done; strong ability to prioritize workload.