Payment Posting Specialist in Holland, Michigan at Shoreline Orthopaedics

The Payment Posting Specialist plays a vital role in supporting the organization's revenue cycle operations by ensuring the accurate and timely posting of insurance and patient payments, reconciliation of deposits, and management of payment adjustments. This position contributes to the achievement of departmental and organizational financial goals while providing exceptional customer service to patients, providers, and team members. The Payment Posting Specialist is expected to conduct all responsibilities with professionalism, accuracy, discretion, and a commitment to maintaining patient confidentiality.

Essential Duties and Responsibilities:

Customer Service and Communication

• Answer billing-related phone calls and assist patients with account inquiries in a professional and courteous manner.
• Collaborate with reimbursement and billing team members to resolve claim denials and payment discrepancies.
• Maintain effective communication with patients, providers, insurance carriers, and internal staff.

Payment Posting and Reconciliation

• Accurately post insurance and patient payments within established timelines.
• Identify and appropriately process denials, payment adjustments, recoupments, and contractual write-offs.
• Monitor payments against contractual agreements to ensure accurate reimbursement.
• Research and resolve unapplied payments, overpayments, underpayments, and payment variances.
• Process recoupments using accurate adjustment and recoupment codes.
• Submit secondary and tertiary insurance claims as required.
• Reconcile daily cash posting batches and deposits to ensure accuracy and completeness.

Refunds and Account Resolution

• Review and process patient and insurance refund requests in accordance with organizational policies.
• Prepare refund documentation and obtain necessary approvals.
• Post and process refunds via check and credit card transactions.
• Review delinquent accounts and assign eligible accounts to approved third-party collection agencies.
• Review and complete financial tasks related to surgical prepayments and other advance payment requirements.

Compliance and Reporting

• Maintain a working knowledge of HIPAA regulations, payer requirements, and healthcare industry standards.
• Protect patient privacy and maintain strict confidentiality of all protected health information.
• Identify and report insurance contract discrepancies, recurring denial trends, and system-related issues to management.
• Assist with audits, reporting, and special projects as assigned.

Additional Responsibilities

• Participate in ongoing training and professional development activities.
• Support departmental process improvement initiatives.

• Strong attention to detail and commitment to accuracy.
• Excellent written and verbal communication skills.
• Professional, courteous, and customer-focused demeanor.
• Strong organizational and time-management skills.
• Ability to prioritize tasks and meet deadlines in a fast-paced environment.
• Pleasant and professional telephone communication skills.
• Positive attitude and ability to work effectively within a team environment.
• Strong problem-solving and analytical abilities.
• Ability to maintain confidentiality and exercise sound judgment.
• Adaptability and willingness to learn new processes, systems, and regulations.

Work Environment

• Must maintain patient confidentiality and comply with all HIPAA regulations and organizational privacy standards.
• Requires continuous learning to remain current with healthcare regulations, payer requirements, and reimbursement processes.
• Frequent deadlines and time-sensitive responsibilities.
• Primarily sedentary position requiring extended periods of sitting and computer work.
• Requires a high degree of concentration, accuracy, and attention to detail.

Education and Experience Requirements

Required:

• High school diploma, GED, or equivalent.
• Minimum of one (1) year of experience in medical billing, payment posting, healthcare revenue cycle operations, or a related healthcare administrative role preferred.
• Basic knowledge of medical insurance terminology, explanation of benefits (EOBs), and payment posting procedures.
• Proficiency with computer systems, data entry, and standard office software applications.

Preferred:

• Experience with electronic health record (EHR) and practice management systems.
• Knowledge of Medicare, Medicaid, commercial insurance plans, and healthcare reimbursement processes.
• Experience working in a physician practice, ambulatory surgery center, or healthcare revenue cycle environment.

Schedule

Days Worked: Monday through Friday

Hours: 8:00 a.m. – 5:00 p.m