Medical Revenue Cycle - Payment Specialist

About the role

The Payment Specialist supports Paradigm's Revenue Cycle operations by managing provider payment processes, resolving discrepancies, and ensuring financial accuracy. This role partners with internal teams and external stakeholders to drive operational efficiency, payment integrity, and exceptional service.

Responsibilities

• Prepare, audit, and generate complex payment files for submission to payment vendors in accordance with established schedules, client requirements, and regulatory guidelines
• Validate payment file accuracy through detailed review of payment data, provider information, offsets, adjustments, and reconciliation balancing
• Submit payment files through designated vendor platforms and ensure successful transmission, receipt, and processing
• Monitor payment submissions for rejections, exceptions, or error notifications and take immediate corrective action to prevent payment delays
• Perform detailed reconciliations between vendor platforms, internal systems, bank reporting, and payment batches to ensure financial accuracy and completeness
• Research, analyze, troubleshoot, and resolve payment file discrepancies, balancing issues, and processing errors in a timely manner
• Serve as a subject matter resource and liaison for provider payment release requests, escalated inquiries, and payment status investigations
• Process payment reissue, void, stop payment, recoupment, and offset requests in accordance with department procedures and compliance standards
• Create and validate client refund files for Accounting department processing and reconciliation
• Collaborate cross-functionally with internal departments, external vendors, banking partners, and IT resources to resolve discrepancies, transmission failures, and file format issues
• Maintain detailed documentation and audit-ready records of payment submissions, corrections, reconciliations, approvals, and outcomes
• Analyze payment activity trends and provide reporting related to payment accuracy, aging, rejection trends, reconciliation findings, and resolution timelines
• Identify operational risks, process inefficiencies, and recurring payment issues and recommend process improvements to enhance accuracy, reduce rework, and improve turnaround times
• Support revenue cycle operations through accurate and timely disbursement processing while ensuring adherence to client contractual obligations and departmental service levels
• Generate, analyze, and reconcile reports from Data Warehouse and applicable systems to identify Provider Accounts Payable due and outstanding payment activity
• Reconcile Jopari payment acknowledgement reports against payment batch files to identify invoices requiring voids, corrections, or internal reprocessing
• Generate Explanation of Reimbursement (EOR) documentation and coordinate distribution processes
• Manage and prioritize the AP queue for provider payment requests, escalations, research items, and inquiries while maintaining service expectations
• Generate and review outstanding AP reports with Manager, Revenue Management and assist in identifying trends, risks, and resolution strategies
• Assist with departmental audits, special projects, workflow enhancements, system testing, and implementation initiatives as assigned
• Provide support and training to team members regarding payment processing workflows, reconciliation procedures, and issue resolution processes
• Maintain confidentiality and safeguard sensitive financial, provider, and client information in compliance with company policies and regulatory standards
• Maintain reliable and predictable attendance during scheduled work hours
• Demonstrate a customer-first mindset by developing a broad and deep understanding of Paradigm organization, products, operations, and customers
• Prioritize collaboration to meet customer needs and expectations and take personal accountability for service quality
• Utilize AI tools to support day-to-day tasks, improve efficiency, and enhance output quality
• Adopt new technologies as trained and apply them in alignment with established processes and guidelines
• Comply with Paradigm Information Security requirements and policies, safeguard passwords, and report Information Security incidents per policy

Requirements

• Acute attention to detail
• Understanding of medical billing, short payments, and denials
• Reconciliation between various systems
• Strong interpersonal skills
• Ability to communicate professionally and effectively on the phone, in person, electronically, or through other means to individuals and groups
• Ability to deal effectively with individuals at all organizational levels
• Proven ability to handle multiple projects while meeting deadlines
• Ability to read and comprehend simple instructions, short correspondence, memos, and other documentation
• Commitment to excellence and high standards
• Ability to work independently and as a member of various teams and committees
• Must be able to speak, read, write, and understand English
• Technical capacity including advanced knowledge of Microsoft Excel and familiarity with Microsoft Access

Benefits

• Health and wellness: PPO, HDHP, and HMO health insurance options with Cigna and Kaiser (CA employees only)
• Financial incentives: Competitive salaries, 401(k) matching contributions, employer-paid life and disability insurance, flexible spending and commuter accounts, and employer-matched HSA contributions
• Vacation: Paid time off and personal holiday programs
• Volunteer time: One paid day per calendar year for full and part-time employees to engage with and give back to their communities
• Learning and development: Support for continual learning and growth, including the Learning Excellence at Paradigm (LEAP) program