Payment Specialist

Our client is a specialty care management entity focused on improving outcomes for individuals with complex injuries and diagnoses. Established in 1991, it operates in the value-based care space, providing risk-based clinical solutions, case management, specialty networks, home health services, shared decision support, and payment integrity programs. The organization emphasizes deep clinical expertise to achieve effective results for patients, payers, and providers.

About the Role

The Payment Specialist is responsible for managing the end-to-end payment process for external vendors and providers, ensuring accuracy, compliance, and timely processing. This role involves resolving complex payment issues, analyzing payment trends, and driving improvements to payment processes. As a subject matter expert, the Payment Specialist collaborates with internal teams and external partners to improve operational efficiency and maintain payment accuracy.

Responsibilities

• Prepare, audit, and generate payment files according to schedules, client requirements, and applicable regulations.
• Validate payment data for accuracy, including provider information and adjustments.
• Submit payment files through vendor platforms and confirm successful processing.
• Monitor and resolve payment rejections, exceptions, and errors promptly.
• Reconcile payment data across vendor platforms, internal systems, and bank reports.
• Research and resolve payment discrepancies and processing issues.
• Serve as a liaison for payment inquiries, release requests, and investigations.
• Process payment reissues, voids, stops, recoupments, and offsets according to established procedures.
• Create and validate refund files for accounting processing.
• Collaborate with internal departments, vendors, banking partners, and IT teams to resolve payment issues.
• Maintain complete documentation and audit-ready records of payment processes.
• Analyze payment trends and report on accuracy, aging, and resolution timelines.
• Identify risks and inefficiencies and recommend process improvements.
• Support revenue cycle operations while ensuring contractual and service-level compliance.
• Generate and reconcile reports to monitor payable and outstanding payment activity.
• Manage provider payment queues, escalations, and inquiries.
• Assist with audits, projects, workflow enhancements, and system testing.
• Provide training and support to team members on payment workflows and reconciliation processes.
• Maintain confidentiality and comply with applicable policies and regulations.
• Demonstrate reliable attendance and a customer-focused approach.
• Utilize AI tools to improve task efficiency and output quality.
• Comply with information security policies and incident reporting requirements.

Requirements

• Strong attention to detail and accuracy.
• Understanding of medical billing, short payments, and denials.
• Experience reconciling data across multiple systems.
• Strong interpersonal and professional communication skills.
• Ability to manage multiple priorities and collaborate effectively in a team environment.