PAYMENT POSTING SPECIALIST

Principal Functions And Responsibilities

• Retrieve and process electronic and manual remittance advice from payers and clearinghouses.
• Prepare, organize, and reconcile insurance payment batches to ensure accurate posting and balancing.
• Post patient and insurance payments accurately and timely to appropriate accounts.
• Verify patient identifiers, dates of service, and account information before posting payments.
• Apply appropriate contractual adjustments, deductibles, copayments, coinsurance amounts, and other payer-specific adjustments.
• Export and process electronic remittance files within revenue cycle systems.
• Reconcile posted payment batches daily and resolve discrepancies to ensure accurate balancing.
• Run and review daily posting reports and reconciliations to verify posting accuracy.
• Research unidentified payments, recoupments, and posting discrepancies to determine appropriate account resolution.

Insurance Payment Analysis & Account Resolution

• Review Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERA) documents and accurately interpret payer adjudication.
• Identify denials, underpayments, payment variances, and reimbursement issues and route accounts for appropriate follow-up.
• Monitor insurance payment trends and reimbursement activity that may impact cash flow.
• Communicate significant reimbursement concerns, payer issues, or payment delays to leadership in a timely manner.
• Absorb and assist with insurance follow-up activities, including denial resolution and account research as assigned.

Credit Balance & Refund Management

• Maintain accurate documentation of payment posting, reconciliation, refund, and adjustment activities.
• Monitor and process all credit balances on a daily basis, ensuring credits are applied, transferred, refunded, or otherwise resolved in accordance with Valor Health policy and established timelines.
• Research and resolve patient and insurance credit balances by identifying the appropriate disposition, including payment transfers, account adjustments, refunds, or other corrective actions.
• Process patient and insurance refunds accurately and timely, ensuring appropriate approvals, documentation, and compliance with organizational policies and regulatory requirements.
• Investigate and resolve payer recoupments, overpayments, and other credit balance discrepancies to ensure accurate account resolution.

Revenue Cycle Support

• Absorb and assist with implementation and optimization of electronic payment posting processes.
• Absorb and assist with billing work queues and other revenue cycle workflows as assigned.
• Absorb and assist with preparing Medicare and Medicaid bad debt documentation and related annual cost report support activities.

Compliance & Documentation

• Maintain accurate documentation of payment posting, reconciliation, refund, and adjustment activities.
• Adhere to Valor Health policies, revenue cycle procedures, and applicable federal and state regulations.
• Ensure compliance with HIPAA and all patient confidentiality requirements.
• Maintain current knowledge of payer rules, reimbursement methodologies, and payment posting best practices.

General Responsibilities

• Work closely with Finance leadership to ensure daily, weekly, monthly, and year-end reconciliation requirements are completed accurately.
• Participate in month-end closing activities and maintain availability during designated closing periods.
• Attend departmental meetings, training sessions, and quality improvement initiatives.
• Maintain effective working relationships with patients, staff, payers, and external partners.
• May be required to work overtime, weekends, or holidays based on operational needs.
• Perform other duties as assigned.