Medical, Payment, Posting, and Reconciliation Specialist

POSITION SUMMARY

Position reports to the Central Billing Supervisor who reports to the Director of Revenue Cycle Management. The Medical Payment Posting & Reconciliation Specialist will monitor A/R aging accessing the accounts for further attention by involving A/R; collect balances to ensure statements are processed and paid promptly. He/she will also manage and reconcile all payments; make sure it is posted into the patients account with the correct amount and adjustment.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Post all insurance and liability payments from Remittance and EOBs to appropriate accounts with minimum errors.
• Apply manual payments and auto payments to accounts for payor types of Medicare Medicaid and Commercial Insurances.
• Analyze EOB information including co-pays deductible co-insurance contractual adjustments denials and more to validate accuracy of patient balances.
• Scan all EOBs into system and creates hardcopy file for original EOBs.
• Add appropriate denial codes and comments to assure all necessary appeals and post payment follow up can take place.
• Investigate the source of unidentified payment to ensure they are applied to appropriate accounts. If necessary will contact the sender to clarify where the payment should be posted.
• Reconcile shortage on both paper and electronic EOBs to determine proper allowance and correct write off.
• Assist in updating the Direct Deposit Daily.
• Assist in performing comparison of downloaded files to the Direct Deposit and correct any discrepancies.
• Assist in setting up Electronic Remittance Advices (ERA) for Commercial and Medicare payors.
• Assist in running and balancing credit cards daily.
• Review deposits and reconcile site logs daily.
• Contact patients insurance or third-party administrators when clarification of information is needed to successfully post payment.
• Handle telephone questions and concerns from customers; ensure complaints and inquiries are reported to management.
• Report all Medicare credits quarterly to Medicare on appropriate form and supply all supporting documentation.
• Research inquiries in a professional and courteous manner and work with Accounts Receivable team members to identify and resolve escalated customer concerns in a timely manner potentially without direct Supervisor oversight. Partner with Team Lead and Supervisor to develop solutions to repeat customer concerns.
• Act as point of contact for the team when Supervisor/Manager/Team Lead are unavailable.
• Responsible for all other duties as assigned.

KNOWLEDGE SKILLS AND ABILITIES REQUIRED

• Data entry skills and working knowledge of computer required.
• Exceptional customer service and interpersonal communication skills.
• Proficient in examining documents for accuracy and completeness.
• Ability to multitask and manage time effectively.
• Ability to handle payment posting in accordance with detailed instructions.
• Ability to add subtract multiply and divide in all units of measure using whole numbers common fractions and decimals. Ability to compute rates ratios and percentages.
• Demonstrable functional knowledge of Microsoft Office applications including Word Outlook and Excel.
• Experience and proficiency with multiple practice management systems. electronic health records and knowledge of and experience with Medicaid and Medicare reimbursement rules and regulations.
• Proficiency utilizing spreadsheet and word processing applications for billing and collections perform detailed analysis and create executive summaries.
• Apply billing and collection requirements of federally qualified health centers (FQHC).
• Communicate with tact and diplomacy with diverse groups of people to include staff and providers governing boards government agencies and insurance companies on behalf of the organization.
• Manage multiple assignments with available resources within established guidelines and deadlines.
• Establish and maintain a goal oriented problem solving results driven environment while performing as a working-assistant supervisor.
• Knowledge and familiarity with compliance programs corporate fully and comply with laws and regulations.

PHYSICAL CHARACTERISTICS/WORKING CONDITIONS

A person in this position must be able to prioritize and respond to the demands of the position. There are frequent opportunities to relax from any physical exertion change position in work activities or break from computer application tasks.

• Physical Effort and Dexterity: Good dexterity to operate personal computer and office equipment. Occasional lifting and carrying related to office duties.
• Machines Tools Equipment required to be operated: Capable of using office machines and personal computers for various computer assisted applications.
• Visual Acuity Hearing and Speaking: Must be able to read a computer monitor and outputs accurately. Must be able to communicate clearly and accurately for work and safety compliance.
• Environment/Working Conditions: Work is mostly inside an office in a controlled environment. Normal office safety precautions and practices are required. Position requires travel throughout the Albuquerque metropolitan area. Work hours are regularly scheduled Monday-Friday although weekends and evenings may be required to meet deadlines and/or responsibilities.

This description lists the major duties and requirements of the job and is not all-inclusive. Applicants may be expected to perform job-related duties other than those contained in this document and may be required to have specific job-related knowledge and skills.

MINIMUM EDUCATION AND EXPERIENCE

• High School diploma or equivalent required; associate or bachelors degree in business Finance or Accounting preferred
• Two years experience in billing and claims in healthcare setting or FCCH billing externship. Education or knowledge may be substituted for the experience requirement.