Medical Billing Payment Poster- Pewaukee

Summary of Role

The Medical Billing Payment Poster is essential for maintaining financial accuracy within the organization. This role involves accurately posting payments from both insurance providers and patients, processing refunds, reconciling accounts, initiating and maintaining electronic remittance advice and payment enrollments. A strong attention to detail is required, along with a solid understanding of medical billing procedures. Proficiency in handling insurance credits, electronic remittances, and account balancing is also necessary. This position requires exceptional analytical skills to efficiently identify and resolve discrepancies while ensuring compliance with industry regulations.

Reports to: CFO

Key Responsibilities

• Verifies calculations and ensures allowed charges, reimbursement amount and contractual disallowance are posted correctly based on the remittance advice.
• Ensure requesting/utilizing the correct adjustment codes as defined in policy at the time of posting and brings incorrect codes to the attention of a supervisor or lead.
• Ensures appropriate amounts are allocated and posted to individual patient accounts and that balancing procedures are maintained for the posting of payment and adjustment batches.
• Responsible to work assigned work queues, reports and spreadsheets to resolve errors or exceptions. May be responsible to download reports or files from secured websites for processing.
• Investigates recoupments, interest payments and miscellaneous payments directed to specific clearing accounts requiring research.
• Calculates self-pay discounts and application of self-pay money.
• Reports overpayments or refunds as necessary when identified during the payment posting process. Brings payment discrepancies to the attention of their supervisor or lead.
• Ensures the daily deposits are posted and balanced per documented procedures.
• Ensures payments and adjustments posted electronically are completed and balanced.
• Balance Daily Bank Deposits to Posted Deposits and works closely with Finance to investigate and resolve any out-of-balance conditions.
• Distributes copies of remittance advices/explanation of benefits to staff as needed.
• Ensures the correct ANSI code or comment code is used when posting denials or partial payments.
• Prioritizes work effectively to prevent backlogs. Communicates workload issues to supervisor or lead.
• Enrolls payers in Electronic Fund Transfers to minimize payment collection lag.
• Evaluates payer for enrollment in Electronic Remittance Advice (ERA) to improve efficiencies in payment posting.
• Triages ERA issues between OAW, EPIC and the Clearinghouse and creates and manages Support tickets until resolved.
• Maintains productivity standards as outlined in the Revenue Cycle department.
• Participate in department meetings, workgroup meetings, and training sessions.
• Ability to adapt to change in a positive, sensitive and forward-thinking manner in demanding situations.
• Provides limited training to partners after becoming efficient, as well as on an as-needed basis for back-up situations.
• Special projects as assigned.

An individual in this position must be able to perform the essential duties and responsibilities listed above successfully. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions of this position.

The above list reflects the general details necessary to describe the principle and essential functions of the position and shall not be construed as the only duties that may be assigned for the position.

Minimum Qualifications

Education: High School Diploma or equivalent

Preferred: Associate Degree in Accounting

Experience:

• 2-4 years of experience in medical billing, payment posting, and account reconciliation.
• Experience with insurance and patient refunds and insurance credits.
• Knowledge of electronic 835 transactions and remittance advice interpretation.
• Familiarity with Claim Adjustment Reason Codes (CARC).
• Proficiency in Excel and ability to perform financial reconciliations.
• Experience balancing accounts and handling bank-to-book transactions.

Preferred: Experience with Epic and other electronic health record (EHR) or billing systems.

Physical and Mental Demands

Communication Skills

Ability to clearly explain billing procedures, insurance details, and payment options to patients, as well as effectively communicate with healthcare providers and insurance companies. Accurate documentation of billing information and patient interactions. Strong interpersonal skills to handle patient inquiries and resolve billing issues in a professional and empathetic manner.

Mathematical Skills

Proficiency in basic math operations for calculating charges, payments, and adjustments. Understanding of billing cycles, insurance reimbursement rates, and payment plans. Ability to perform reconciliations and handle financial discrepancies. Ability to analyze billing data, identify trends, and detect errors or inconsistencies. 

Judgement and Decision Making

Ability to identify billing issues, investigate causes, and implement solutions. Prioritizing tasks based on urgency and importance. Evaluating complex billing situations, making informed decisions, and considering the potential impact on patients and the hospital. Ensuring all billing practices comply with legal and regulatory standards, maintaining patient confidentiality, and handling sensitive information responsibly. Ability to work under pressure, meet deadlines, and handle multiple tasks simultaneously. 

Software and Technology

Skilled in using medical billing software and electronic health records systems. Familiarity with coding software and tools. Accurate and efficient data entry skills for processing patient information, billing codes, and insurance details. Ability to learn and adapt to new technologies and software updates. Proficiency in using office software for documentation and reporting.

Work Environment

The primary work environment is hybrid-based. This position requires two days a week in the office and three days remote. The noise level in the work environment is usually moderate. Must be able to lift, push, pull up to 50 lbs.  

The mental and physical requirements described here are representative of those that must be 

met by an individual to successfully perform the essential functions of this position.

Equal Employment Opportunity

OAW provides equal employment opportunity to all applicants and employees. OAW disapproves of, and will not tolerate, unlawful discrimination against any applicant or employee because of race, color, national origin or ancestry, gender (including pregnancy, childbirth, or related medical conditions), gender identity, age, religion, disability, family care status, veteran status, marital status, sexual orientation, or any other basis protected by local, state, or federal laws.