At Independence Physician Management (IPM), we are looking for exceptional people who share our vision and values, who share our focus on hard work, enthusiasm, teamwork, loyalty, trust and cooperation. We've embraced these traits and built a team of employees who consistently work to achieve the highest level of service excellence. People are our most valuable resource at UHS as we are committed to providing high quality acute care and behavioral health services to residents of the communities we serve. We are equally committed to offering our employees unlimited opportunity in an environment that encourages professional development. The Payment Specialist is responsible for:
The accurate and timely import and processing of Electronic Remittance Advices (ERAs) and manual payment posting to PMS to meet team goals and objectives.
Confirms Electronic Funds Transfer (EFT) and deposits (including lockbox) and processes payments following IPM CBO guidelines.
Performs timely and accurate ERA reconciliation to include ERA processing, Process Level Adjustments (PLB) and credits applied to the PMS following the processing of an ERA file to minimize lag days.
Meets or exceeds established performance targets (productivity and quality) established by the Payments Supervisor.
Exercises good judgment in escalating identified payer specific ERAs that are not posting 100% to the Practice Management System (PMS) to maximize automated processing opportunities.
Escalates payer EFT/deposits that are received without corresponding Explanation of Benefits (EOBs) or ERA file to maximize payer ERA enrollment.
Demonstrates the ability to be an effective team player. Upholds "best practices" in day to day processes and work flow standardization to drive maximum efficiencies across the team.
Accurate and timely import of payer assigned electronic remittance advice (ERA) files received from the clearinghouse following verification of electronic funds transfer (EFT) or deposit.
Accurate and timely processing of ERA files to PMS to minimize lag days.
Meets or exceeds established performance targets (productivity and quality) established by the Billing Supervisor.
Confirms the electronically posted payments total in PMS against EFT/deposit total. Identifies payments that did not post electronically and manually posts payments to PMS and handles Provider Level Adjustments (PLB) and other credits applied to PMS following the ERA process, to achieve a successful reconciliation result (PMS ERA total is equal to EFT/deposit total)
Timely and accurate manual payment posting of non-ERA insurance payments, Accurately reviews and resolves assigned claim and clearinghouse edits and payer rejections to minimize lag days. Meets or exceeds established performance targets (productivity and quality) established by the Billing Supervisor.
Retrieves Explanation of Benefits (EOBs), as needed, for EFT/deposits received from paperless payers who are not set up for ERA. Provides prompt notification of these payers to the Billing Supervisor to maximize opportunities to enroll for ERA.
Identifies zero dollar payments/insurance denials and forwards EOB information to the appropriate Accounts Receivable team timely to drive prompt resubmission and appeals processing.
Effectively prioritizes work assignments and demonstrates flexibility in assuming payer specific manual payment posting batches and ERA files assigned to other Reimbursement Specialists to minimize lag days and ensure team goals/objectives are met.
Participates in regularly scheduled team meetings offering new paths, procedures and approaches to manual payment posting, ERA processing, PLB adjustments and credit balances to maximize opportunities for performance and process improvement.