Revenue Billing/ Collection/Payment Reconciliation Specialist

Description of Responsibilities

The Payment Reconciliation Specialist is responsible for overseeing all facets of the payment posting process. They are responsible for processing remits, payment reconciliation and discrepancy identification between expected reimbursements and actual payments including denials, recoupments and underpayments.

The Revenue Billing and Collection Specialist is responsible for overseeing all facets of the billing process. They are responsible for understanding and coding all procedures within payor and self pay regulations and guidelines. This position is responsible for coordinating overall functions of the billing process including coding, charge entry, denials, and accounts receivable. They work to maximize cash flow while improving patient, provider and other customer relations.

Responsibilities include the following:

Payment Reconciliation

• Posting payments both electronically and manually, maintaining accurate medical billing records, and documenting revenue from patient payments and insurance reimbursements. All forms of payment will be delivered to the Payment Specialist.
• Perform daily reconciliation with the EFT bank deposit transactions and the ERA transactions for the day (EFT/Operating Accounts) with daily logs and/or other documents as required.
• Work closely with the Director of Revenue Cycle Management on the daily process and balancing.
• Balance “Lockbox” and report on end of day spreadsheet (paper remits).
• Post ERA (electronic remittances) transactions from the Clearinghouse.
• Work with various IT platforms, clearinghouses, depositors and billing portals as needed, following all HIPAA guidelines in order with FICA, AMA and SVMIC.
• Pull EOB’s or 835’s, if applicable (Vpay, Payspan, Echo, Availity, etc.).
• Sort and post check and credit card payments by insurance companies.
• Must be able to verify the accuracy of information between the EOB and the billing system Properly posting rejection codes, adjustments, and payments per the EOB for proper denial tracking and analysis.
• Verifying all payments have the correct information (authorization numbers, patients accounts, etc.) and have been posted to the CPT level.
• Research misapplied payments and adjust reconcile accounts.
• Take credit card payments by phone or mail and process through Stripe, reconciling all receipts with bank log. Serve as the Stripe resource for other team members.
• Create and maintain a daily spreadsheet for deposit reconciliation.
• Reconcile and communicate the following information to the Director of Revenue Cycle Management and other identified parties: Proofed bank sheet to make sure all items are accounted and in current order; “Daily Close” balance for the day prior for all clinics; Month End
• Work any recoupment requests sent by Medicare and/or Commercial Insurance payers. Assign to Denial Representatives to research the reason for the recoupment to make sure it is valid.
• Create and send statements at the end of month.
• Post all returned checks
• Learns and retains knowledge about patients and types of services being rendered. Interprets patient and insurance issues and determines resolutions in a timely and accurate manner.
• Maintains current knowledge of governmental and managed care regulations and policies and procedures. Interprets and communicates regulations to ensure compliance.
• Make sure all documents (EOBs, collection correspondence, end of day/end of month/end of year paperwork, refunds, returned checks, all payment information, bankruptcy, accountant miscellaneous correspondence) are documented as directed by management.

Charge Entry– Daily

• Create claims by entering charges from provider’s progress notes (as assigned per staff member) within each insurance’s timely filing periods.
• Adjust for specific no charge encounters.
• Make corrections to demographic and insurance information for claims to process.
• Performs required routine or assigned daily tasks.
• Proofs all notes, codes, authorizations and modifiers, ensuring billing information is correct prior to claim submission.

Denials– Daily

• Work insurance denials and aging to resolve rejected claims and other issues preventing claims from being placed in adjudication.
• Print Paper Claims in primary, secondary and tertiary batches as needed
• Verify the accuracy of information between the EOB and the billing system. Properly post rejection codes per the EOB for proper denial tracking and analysis. Retain time-stamped updated and/or corrected documentation for timely insurance filing.
• Attend all billing related in-person, chats, calls and video meetings as required.
• Learns and retains knowledge about patients and types of services being rendered including, but not limited to, CPT, ICD10 and HCPCS coding.
• Remains current with governmental and managed care regulations and policies and procedures and communicates same to the organization.
• Demonstrates ability to audit and review accounts for reimbursement in accordance with billing regulations, medical terminology, and coding requirements.
• Interprets patient and insurance issues and determines resolutions in a timely and accurate manner.
• Make sure all documents (encounter forms, EOBs, recoupments, and other miscellaneous correspondence) are retained electronically as directed.

Phone Duties

• Answer Billing Department calls as necessary – including patient questions and resolve any issues. Direct the call to other areas of the billing department as necessary.
• Resolve any detailed account questions from calls transferred by other billing personnel.
• Keep all calls at a courteous and professional level. If any call results in a disgruntled patient/guarantor, please forward it to the manager.
• Always remember when speaking with patient/guarantor, do not provide medical advice, but forward to the appropriate medical/clinical staff

Other Duties

• Attend all billing chats, video and in-office meetings, reply to all inter-billing office correspondence in a timely, professional manner.
• Effectively communicates with other departments and clients to request information, as well as to review issues, concerns effecting reimbursement.
• Makes recommendations to management, actively participates in continuous quality improvement, and enhances reimbursement.
• Adheres to organizational policy with particular attention to standards of conduct and to confidentiality as it relates to HIPAA.
• Assist Partners, Directors, Patient Service Representatives, Accountant and Managers as needed.
• Any other projects as assigned by leadership.

Minimum Qualifications

• Must possess a bachelor’s degree or equivalent experience
• Computer literacy, including knowledge of software applications and familiarity with MS Office, electronic health records, internet, and mobile applications
• A friendly personality with good people skills including team collaboration
• Exhibits attention to detail and critical thinking problem solving
• Excellent written communication skills

Physical Requirements

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions in this job description:

1. The employee is regularly required to stand, walk, and sit, as well as talk and hear.

2. Good hand-eye coordination and the ability to lift up to at least 25 pounds.

Job Type: Full-time

Pay: $16.00 - $19.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 10 hour shift
• No weekends

Work Location: Remote

Salary : $16 - $19