Payment Poster (Administrative)

The primary responsibilities of this position are ensuring payments received from the insurance companies are posted correctly to the patient accounts; ensuring denials and unpaid or partially paid claims are thoroughly researched; to provide specialized assistance to our patients and clinical staff using their knowledge base of a particular insurance; to provide excellent patient service.

SPECIFIC JOB DUTIES AND RESPONSIBILITES:

Posting insurance payments using established procedures.
Notify the g4 Helpdesk if an Insurance Payer appears in Resolve has not been mapped in the system.
Contacting insurance companies when clarification is needed in order to post payments.
Work tasks through Unity to assure payments are posted correctly and add appropriate notes indicating action taken before marking task as completed.
Review adjustments prior to posting to assure adjustments are applied correctly at time of posting.
Post adjustments to closed tickets from Complete Care balancing to the weekly report from Complete Care.
Post adjustments on bad debt accounts.
Post refunds once processed through accounts payable.
Balance payments and adjustment before closing.
Immediately notify the appropriate team member when a denial of a high dollar drug or procedure is posted.
Bringing new reimbursement issues to the attention of the Director Business Office and/or VP Revenue Cycle: Change in reimbursement for a particular code, Denial for out-of-network, Bundling/unbundling of CPT codes, Denial of services that should have, and normally would have, been paid, Decrease in volume and/or dollar amounts of remits, Partially paid claims
Notifying appropriate person in Accounting when payments are received for bad debt balances.

EDUCATION, CERTIFICATION, LICENSURE, REGISTRATION:

High School Diploma or equivalent

EXPERIENCE, KNOWLEDGE, SKILLS and ABILITIES:

Minimum of two years of medical office billing experience
Knowledge of clinic policies and procedures
Knowledge of medical terminology and insurance practices
Knowledge of computer programs and applications
Knowledge of grammar, spelling, and punctuation to type correspondence
Skilled in gathering, interpreting, and reporting insurance information
Skilled in trouble-shooting insurance problems and claims
Ability to identify claim problems and recommend solutions
Ability to sort and file insurance forms and associated information

REASONING ABILITY:

Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
Ability to interpret a variety of instructions furnished in written, oral, or schedule form.

INTERPERSONAL SKILLS:

Must interact and communicate both verbally and in written form.
Must interact and exchange information regarding patients with physicians and other departmental personnel, and outside agencies on a frequent basis while respecting the confidentiality of patient information.

PHYSICAL DEMANDS:

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.
While performing the duties of this job, the employee is regularly required to talk or hear.
The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
Specific vision abilities required by this job include close vision and the ability to adjust focus.

WORK ENVIRONMENT:
The work environment described here are representative of those an employee encounters while performing the essential functions of this job. This position involves potential exposure to infectious diseases. Colleagues are offered appropriate vaccinations and safety training.

COMMENTS:
This description is intended to describe the essential job functions, the general supplemental functions and the essential requirements for the performance of the job. It is not an exhaustive list of all duties, responsibilities and requirements of a person so classified. Other functions may be assigned and management retains the right to add or change the duties at any time. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.