Revenue Integrity & Payment Reconciliation SME
Altivera Medical · Denver, CO · 1 mo ago
AccountingFull-time
We need to output HTML fragment with sections: h3 for headings like About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. We must include sections only if posting has real specific content. The posting includes description of role, responsibilities, competencies, essential duties, minimum qualifications, preferred qualifications, KPIs. No explicit Benefits, Pay, Schedule. So we should not create those sections. We need sections: About the role (maybe from description), Responsibilities (essential duties), Requirements (minimum qualifications), Qualifications (maybe preferred qualifications?), Skills (maybe competencies). But we must not repeat job title as heading. The page already shows it. We need to decide which headings to use based on content.
We have:
- Description paragraph: "This role ensures reimbursement transactions are accurately reconciled..." That's about the role. Could be About the role.
- Critical Competencies: list of competencies (Financial Reconciliation Expertise, Revenue Cycle & Reimbursement Knowledge, etc.) Could be Skills.
- Essential Duties And Responsibilities: list of duties -> Responsibilities.
- Minimum Qualifications: list -> Requirements.
- Preferred Qualifications: list -> Qualifications (or maybe also Skills). But we already used Skills for competencies; we could treat Preferred Qualifications as Qualifications.
- Success will be measured against KPIs: could be a section maybe "Performance Metrics" but not in allowed headings. Allowed headings are limited to About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. So we could put KPIs under Skills? Not ideal. Maybe we can add a section "Qualifications" for preferred qualifications and include KPIs there? Or we could add a section "Skills" for competencies and KPIs? The instruction: "Prefer a few substantive sections over many thin ones." So we could combine.
We need to preserve all substantive information. So we must include KPIs somewhere. Could be under a heading "Skills" but that's not accurate. Could be under "Qualifications" as part of preferred qualifications? But KPIs are not qualifications. Could be under "Responsibilities"? Not exactly. Could be under "About the role"? Not.
Maybe we can create a section "Skills" for competencies and also include KPIs as part of Skills? Might be okay but risk of misrepresenting.
Alternatively, we could create a section "Qualifications" for both minimum and preferred qualifications, and put KPIs under a separate heading like "Performance Metrics" but that's not allowed. The instruction says: use h3 for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). It says "e.g." meaning those are examples, not exclusive? It says "use for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule)." Likely they expect only those headings. So we must stick to those.
Thus we need to map content to those headings.
We have:
- About the role: description paragraph.
- Responsibilities: Essential Duties And Responsibilities.
- Requirements: Minimum Qualifications.
- Qualifications: Preferred Qualifications.
- Skills: Critical Competencies (and maybe also KPIs? but we could include KPIs under Skills as part of performance expectations? Might be okay.)
We must not include Benefits, Pay, Schedule.
We must not repeat job title as heading.
We must not include boilerplate.
We need to output only HTML fragment, no html/body tags, no markdown fences.
We need to use
for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule)." Likely they expect only those headings. So we must stick to those.
Thus we need to map content to those headings.
We have:
- About the role: description paragraph.
- Responsibilities: Essential Duties And Responsibilities.
- Requirements: Minimum Qualifications.
- Qualifications: Preferred Qualifications.
- Skills: Critical Competencies (and maybe also KPIs? but we could include KPIs under Skills as part of performance expectations? Might be okay.)
We must not include Benefits, Pay, Schedule.
We must not repeat job title as heading.
We must not include boilerplate.
We need to output only HTML fragment, no html/body tags, no markdown fences.
We need to use - for any list of duties/requirements/benefits, and
for prose.
We need to preserve all substantive information; do not invent or summarize away detail.
We need to remove duplicated lines.
We need to format lists appropriately.
Let's extract content.
About the role: The first paragraph: "This role ensures reimbursement transactions are accurately reconciled, properly posted, supported, and operationally resolved across Commercial, Workers’ Compensation, Personal Injury, and patient-pay revenue streams. The Revenue Integrity & Payment Reconciliation SME partners with Revenue Operations, Revenue Recovery & Resolution, Finance, Payer Relations, and NikoHealth enrollment resources to improve cash application, reduce manual payment processing, and strengthen financial controls."
That's it.
Responsibilities: Essential Duties And Responsibilities includes multiple bullet-like paragraphs. We need to turn each duty into
- . The text includes sections: Financial Reconciliation Operations, ERA and EFT Enrollment Support and Workflow Activation, Revenue System Operations, Payment Posting and Remittance Validation, Financial Exception Management, Reporting, Analytics, and Continuous Improvement. Each has multiple sentences. We should break each sentence or each duty into list items. The instruction: use
- for any list of duties/requirements/benefits. So we can treat each duty as a list item. We need to preserve all substantive information; we can split into multiple
- items for each distinct duty.
Let's list duties:
From "Financial Reconciliation Operations":
- Reconcile payments, remittances, deposits, credits, refunds, adjustments, write-offs, and posted balances.
- Investigate differences among claims, remittances, deposits, posted payments, and account balances.
- Validate payment-posting activity for accuracy, completeness, and appropriate allocation.
- Research and resolve unapplied cash, unidentified payments, duplicate postings, and unsupported adjustments.
- Maintain reconciliation workpapers, supporting documentation, and audit trails.
- Support month-end reconciliation activities and operational financial reporting.
From "ERA and EFT Enrollment Support and Workflow Activation":
- Identify payers, carriers, TPAs, and reimbursement sources using paper checks, paper remittance advice, or other manual payment workflows.
- Monitor payment and remittance activity to identify opportunities for ERA and EFT enrollment.
- Initiate and trigger the appropriate operational workflow when an ERA or EFT opportunity is identified.
- Coordinate with Revenue Operations, NikoHealth enrollment resources, Payer Relations, Contracting, Finance, clearinghouses, and other stakeholders to ensure opportunities are reviewed and actioned.
- Maintain an inventory of ERA and EFT opportunities, required documentation, assigned owners, status, barriers, and completion dates.
- Track open enrollment requests and escalate unresolved operational barriers.
- Support stakeholders with payer information, enrollment documentation, and payment-pattern evidence.
- Validate that newly activated ERA and EFT workflows are producing expected remittance and payment activity.
- Monitor post-implementation performance and identify remaining manual payment workflows.
- Report paper-check volume, paper-remittance volume, electronic-payment adoption, and open enrollment opportunities.
From "Revenue System Operations":
- Partner with Revenue Operations to identify remittance, posting, and reconciliation inefficiencies.
- Collaborate with NikoHealth enrollment resources to initiate and support payer enrollment workflows.
- Provide payer, payment, and remittance information needed for enrollment review and implementation.
- Participate in operational testing and validation after enrollment activation.
- Maintain documentation of payment-delivery methods and remittance workflows.
- Identify workflow improvements that reduce manual posting and reconciliation effort.
From "Payment Posting and Remittance Validation":
- Review ERA, paper remittance, EFT, paper check, and other payment activity for accuracy and completeness.
- Investigate payment allocation discrepancies, posting variances, and missing remittance information.
- Monitor payment-application trends and recurring posting defects.
- Validate adjustments and write-offs for appropriate application and supporting documentation.
- Support correction of identified posting errors and confirm completion.
From "Financial Exception Management":
- Maintain reconciliation exception work queues, inventories, and tracking logs.
- Investigate unresolved financial transactions and discrepancies affecting account balances.
- Document the issue, root cause, financial impact, assigned owner, next action, and resolution status.
- Escalate unresolved, high-risk, or recurring financial findings.
- Analyze exception trends and recommend controls or workflow improvements.
From "Reporting, Analytics, and Continuous Improvement":
- Develop and maintain reconciliation reports, enrollment trackers, and operational dashboards.
- Track unapplied cash, posting exceptions, remittance issues, reconciliation aging, and unresolved variances.
- Quantify the operational and financial impact of reconciliation issues and manual payment workflows.
- Identify opportunities to automate payment, remittance, cash-application, and reconciliation processes.
- Support workflow standardization, documentation, NikoHealth optimization, and continuous improvement initiatives.
- Provide timely, accurate, and decision-ready reporting to department leadership.
Now Requirements (Minimum Qualifications):
- Associate or bachelor’s degree in accounting, Finance, Business Administration, Healthcare Administration, Revenue Cycle Management, or a related field, or an equivalent combination of education and directly related experience.
- Five or more years of healthcare revenue-cycle, reconciliation, payment-posting, cash-application, accounts-receivable, billing, or financial-operations experience.
- Demonstrated knowledge of remittances, ERA processing, EFT workflows, payment posting, adjustments, write-offs, unapplied cash, and reconciliation principles.
- Experience investigating complex financial transactions and documenting supported resolutions.
- Advanced Microsoft Excel skills and experience maintaining reconciliation or operational tracking tools.
- Strong analytical, organizational, documentation, communication, and cross-functional coordination skills.
- Ability to work independently, manage competing priorities, and follow issues through resolution.
Qualifications (Preferred Qualifications):
- DME/HME experience with revenue-cycles.
- NikoHealth or comparable healthcare revenue-cycle platform experience.
- ERA and EFT enrollment support or implementation experience.
- Healthcare finance, accounting, cash-application, or payment-posting experience.
- Clearinghouse and payer-portal experience.
- Power BI or advanced reporting experience.
- Revenue-cycle, healthcare-finance, accounting, Lean, or process-improvement certification.
Skills (Critical Competencies):
We need to list each competency as list items.
Critical Competencies list:
- Financial Reconciliation Expertise: Strong knowledge of claim-to-cash reconciliation, cash application, payment allocation, deposits, credits, refunds, adjustments, write-offs, unapplied cash, and financial exception resolution.
- Revenue Cycle & Reimbursement Knowledge: Comprehensive understanding of healthcare revenue cycle operations, reimbursement workflows, payer behavior, remittance processing, and the financial relationships among claims, payments, account balances, and adjustments.
- Remittance & Payment Processing: Ability to interpret ERA and paper remittance activity, validate payment-posting accuracy, investigate missing or mismatched remittances, and identify posting defects or allocation issues.
- ERA/EFT Workflow Coordination: Experience identifying electronic-payment opportunities, initiating ERA/EFT workflows, coordinating payer and internal stakeholders, tracking enrollment barriers, and validating successful activation.
- Analytical Thinking & Exception Management: Ability to investigate complex financial discrepancies, identify root causes and trends, quantify operational impact, prioritize exceptions, and drive issues through resolution.
- Process Improvement & Operational Controls: Ability to identify manual or inefficient payment workflows, strengthen reconciliation controls, support automation and system optimization, and improve audit readiness and financial accuracy.
- Cross-Functional Collaboration & Accountability: Strong ability to coordinate across Revenue Operations, Finance, Payer Relations, Contracting, clearinghouses, and enrollment resources while maintaining clear ownership, documentation, escalation, and follow-through.
We could also include KPIs under Skills? But maybe we can add a separate section "Skills" for competencies and also include KPIs as part of Skills? Might be okay but could be considered adding extra content not originally under Skills. However we need to preserve all substantive information; KPIs are substantive. If we don't include them, we lose info. So we need to include KPIs somewhere. Perhaps we can add a subsection under Skills as a list of KPIs. The instruction: "Use
- for any list of duties/requirements/benefits". KPIs are not duties/requirements/benefits but they are a list. Could still be a list. We'll include them under Skills as a sublist? But we need to output only HTML fragment; we can nest lists.
Better: we could create a section "Skills" and within it have two sub-sections: Competencies and KPIs. But we cannot add extra headings beyond h3. We could just have a
for prose. We need to preserve all substantive information; do not invent or summarize away detail. We need to remove duplicated lines. We need to format lists appropriately. Let's extract content. About the role: The first paragraph: "This role ensures reimbursement transactions are accurately reconciled, properly posted, supported, and operationally resolved across Commercial, Workers’ Compensation, Personal Injury, and patient-pay revenue streams. The Revenue Integrity & Payment Reconciliation SME partners with Revenue Operations, Revenue Recovery & Resolution, Finance, Payer Relations, and NikoHealth enrollment resources to improve cash application, reduce manual payment processing, and strengthen financial controls." That's it. Responsibilities: Essential Duties And Responsibilities includes multiple bullet-like paragraphs. We need to turn each duty into
- for any list of duties/requirements/benefits. So we can treat each duty as a list item. We need to preserve all substantive information; we can split into multiple
- items for each distinct duty.
Let's list duties:
From "Financial Reconciliation Operations":
- Reconcile payments, remittances, deposits, credits, refunds, adjustments, write-offs, and posted balances.
- Investigate differences among claims, remittances, deposits, posted payments, and account balances.
- Validate payment-posting activity for accuracy, completeness, and appropriate allocation.
- Research and resolve unapplied cash, unidentified payments, duplicate postings, and unsupported adjustments.
- Maintain reconciliation workpapers, supporting documentation, and audit trails.
- Support month-end reconciliation activities and operational financial reporting.
From "ERA and EFT Enrollment Support and Workflow Activation":
- Identify payers, carriers, TPAs, and reimbursement sources using paper checks, paper remittance advice, or other manual payment workflows.
- Monitor payment and remittance activity to identify opportunities for ERA and EFT enrollment.
- Initiate and trigger the appropriate operational workflow when an ERA or EFT opportunity is identified.
- Coordinate with Revenue Operations, NikoHealth enrollment resources, Payer Relations, Contracting, Finance, clearinghouses, and other stakeholders to ensure opportunities are reviewed and actioned.
- Maintain an inventory of ERA and EFT opportunities, required documentation, assigned owners, status, barriers, and completion dates.
- Track open enrollment requests and escalate unresolved operational barriers.
- Support stakeholders with payer information, enrollment documentation, and payment-pattern evidence.
- Validate that newly activated ERA and EFT workflows are producing expected remittance and payment activity.
- Monitor post-implementation performance and identify remaining manual payment workflows.
- Report paper-check volume, paper-remittance volume, electronic-payment adoption, and open enrollment opportunities.
From "Revenue System Operations":
- Partner with Revenue Operations to identify remittance, posting, and reconciliation inefficiencies.
- Collaborate with NikoHealth enrollment resources to initiate and support payer enrollment workflows.
- Provide payer, payment, and remittance information needed for enrollment review and implementation.
- Participate in operational testing and validation after enrollment activation.
- Maintain documentation of payment-delivery methods and remittance workflows.
- Identify workflow improvements that reduce manual posting and reconciliation effort.
From "Payment Posting and Remittance Validation":
- Review ERA, paper remittance, EFT, paper check, and other payment activity for accuracy and completeness.
- Investigate payment allocation discrepancies, posting variances, and missing remittance information.
- Monitor payment-application trends and recurring posting defects.
- Validate adjustments and write-offs for appropriate application and supporting documentation.
- Support correction of identified posting errors and confirm completion.
From "Financial Exception Management":
- Maintain reconciliation exception work queues, inventories, and tracking logs.
- Investigate unresolved financial transactions and discrepancies affecting account balances.
- Document the issue, root cause, financial impact, assigned owner, next action, and resolution status.
- Escalate unresolved, high-risk, or recurring financial findings.
- Analyze exception trends and recommend controls or workflow improvements.
From "Reporting, Analytics, and Continuous Improvement":
- Develop and maintain reconciliation reports, enrollment trackers, and operational dashboards.
- Track unapplied cash, posting exceptions, remittance issues, reconciliation aging, and unresolved variances.
- Quantify the operational and financial impact of reconciliation issues and manual payment workflows.
- Identify opportunities to automate payment, remittance, cash-application, and reconciliation processes.
- Support workflow standardization, documentation, NikoHealth optimization, and continuous improvement initiatives.
- Provide timely, accurate, and decision-ready reporting to department leadership.
Now Requirements (Minimum Qualifications):
- Associate or bachelor’s degree in accounting, Finance, Business Administration, Healthcare Administration, Revenue Cycle Management, or a related field, or an equivalent combination of education and directly related experience.
- Five or more years of healthcare revenue-cycle, reconciliation, payment-posting, cash-application, accounts-receivable, billing, or financial-operations experience.
- Demonstrated knowledge of remittances, ERA processing, EFT workflows, payment posting, adjustments, write-offs, unapplied cash, and reconciliation principles.
- Experience investigating complex financial transactions and documenting supported resolutions.
- Advanced Microsoft Excel skills and experience maintaining reconciliation or operational tracking tools.
- Strong analytical, organizational, documentation, communication, and cross-functional coordination skills.
- Ability to work independently, manage competing priorities, and follow issues through resolution.
Qualifications (Preferred Qualifications):
- DME/HME experience with revenue-cycles.
- NikoHealth or comparable healthcare revenue-cycle platform experience.
- ERA and EFT enrollment support or implementation experience.
- Healthcare finance, accounting, cash-application, or payment-posting experience.
- Clearinghouse and payer-portal experience.
- Power BI or advanced reporting experience.
- Revenue-cycle, healthcare-finance, accounting, Lean, or process-improvement certification.
Skills (Critical Competencies):
We need to list each competency as list items.
Critical Competencies list:
- Financial Reconciliation Expertise: Strong knowledge of claim-to-cash reconciliation, cash application, payment allocation, deposits, credits, refunds, adjustments, write-offs, unapplied cash, and financial exception resolution.
- Revenue Cycle & Reimbursement Knowledge: Comprehensive understanding of healthcare revenue cycle operations, reimbursement workflows, payer behavior, remittance processing, and the financial relationships among claims, payments, account balances, and adjustments.
- Remittance & Payment Processing: Ability to interpret ERA and paper remittance activity, validate payment-posting accuracy, investigate missing or mismatched remittances, and identify posting defects or allocation issues.
- ERA/EFT Workflow Coordination: Experience identifying electronic-payment opportunities, initiating ERA/EFT workflows, coordinating payer and internal stakeholders, tracking enrollment barriers, and validating successful activation.
- Analytical Thinking & Exception Management: Ability to investigate complex financial discrepancies, identify root causes and trends, quantify operational impact, prioritize exceptions, and drive issues through resolution.
- Process Improvement & Operational Controls: Ability to identify manual or inefficient payment workflows, strengthen reconciliation controls, support automation and system optimization, and improve audit readiness and financial accuracy.
- Cross-Functional Collaboration & Accountability: Strong ability to coordinate across Revenue Operations, Finance, Payer Relations, Contracting, clearinghouses, and enrollment resources while maintaining clear ownership, documentation, escalation, and follow-through.
We could also include KPIs under Skills? But maybe we can add a separate section "Skills" for competencies and also include KPIs as part of Skills? Might be okay but could be considered adding extra content not originally under Skills. However we need to preserve all substantive information; KPIs are substantive. If we don't include them, we lose info. So we need to include KPIs somewhere. Perhaps we can add a subsection under Skills as a list of KPIs. The instruction: "Use
- for any list of duties/requirements/benefits". KPIs are not duties/requirements/benefits but they are a list. Could still be a list. We'll include them under Skills as a sublist? But we need to output only HTML fragment; we can nest lists. Better: we could create a section "Skills" and within it have two sub-sections: Competencies and KPIs. But we cannot add extra headings beyond h3. We could just have a