Payment Application & Reconciliation Specialist

ESSENTIAL FUNCTIONS

• Has an understanding of accounts receivable posting process for medical billing including charges, payments and adjustments.
• Reconcile posting financial transactions through use of the automated systems and team processes.
• Accurately interprets insurance explanation of benefits to ensure proper posting.
• Retrieves and uploads 835 and paper remittance files into patient account system ensuring file reconciliation, including reviewing and matching charges.
• Participation in optimizing productivity within area.
• Maintains knowledge of the work area and optimizes use of available technology.
• Establishes and maintains effective communication with physicians, staff and other departments as required.
• Accepts and completes additional requests from the Cash Applications Supervisor and Management.
• Adheres to and understands the Business Office rules and regulations regarding Medicare and HIPAA guidelines.
• Effectively forwards accounts requiring work up or resubmission to the business office staff.
• The job holder must demonstrate current competencies for job position.
• The job holder must make necessary phone calls to insurance payers to obtain remittance or have payments reissued.

EDUCATION

• High school diploma/GED or equivalent working knowledge preferred.

EXPERIENCE

• A minimum of two years’ experience in medical billing and/or cash applications or equivalent experience in a healthcare environment.
• Prefer previous cash posting experience in a multiple lockbox environment. 
• Must be able to communicate effectively and be capable of establishing good working relationships with both internal and external customers.

KNOWLEDGE

• Knowledge of revenue cycle processes.
• Knowledge of computer systems. Experience with Athena One/Athena Health management system preferred.

• Skill in customer service and an understanding of HOPCo’s code of conduct and culture.
• Skill in using computer programs and Microsoft applications.
• Skill in establishing good working relationships with both internal and external customers.

ABILITIES

• Ability to examine and interpret insurance documents including but not limited to eligibility responses and explanation of benefits (EOB).
• Ability to review postings and reconcile daily receipts.
• Ability to communicate clearly and effectively.                                                                                                                     

ENVIRONMENTAL WORKING CONDITIONS

• Normal office environment when in office.

PHYSICAL/MENTAL DEMANDS

• Requires sitting and standing associated with a normal office environment. Some bending and stretching required. Manual dexterity using a calculator and computer keyboard.

ORGANIZATIONAL REQUIREMENTS

• HOPCo Mission, Vision and Values must be acknowledged and adhered to
• List additional organization requirements such as training conducted by organization

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.