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Variety Care, Inc Payment Specialist in Oklahoma City, Oklahoma

Department: Billing

Position: Payment Specialist

Employee Category: Non-Exempt

Reporting Relationship: Manager of Revenue Cycle Management

Character First qualities:

  • Decisiveness- The ability to recognize key factors and finalize difficult decisions.

  • Dependability- Fulfilling what I consented to do, even if it means unexpected sacrifice

  • Initiative – Recognizing and doing what needs to be done before I am asked to do it.

  • Thoroughness – Knowing what factors will diminish the effectiveness of my work or words, if neglected.

  • Flexibility – Willingness to change plans or ideas without getting upset.

Summary of Duties and Responsibilities:

The Payment Specialist is responsible for ensuring all payments are processed accurately in a timely manner, handling refund requests and analyzing explanation of benefits (EOBs) for errors in claims and payment processing.

Primary Duties and Responsibilities:

  • Retrieve electronic payments and EOB’s online and save to a designated location.

  • Accurately and consistently scan and post insurance payments and adjustments of remittance advices received via paper or electronically into the Electronic Health Records (EHR) ensuring that the patient balance is correct.

  • Accurately and consistently post patient payments and refunds in to the EHR.

  • Scan and post EOB denials and refunds into the EHR and accurately apply to the patient’s account.

  • Identify and locate missing remittance advices by using payer websites and/or contacting the payers directly.

  • Analyze claims during the posting process to determine whether they were processed accurately. Notify a Claims Resolution Specialist if any issues are discovered based upon verification of benefits or missing information including pre-certs or claim errors.

  • Track and report ongoing issues and trends to the Manager of Revenue Cycle Management.

  • Handle all refund requests from insurance, to include researching issues to determine if refunds are due, requesting payment from AP/processing through payer portal, and posting recoupments in the EHR.

  • Follow standard operating procedures (SOP) protocols and established guidelines for each payor.

  • Post daily deposits on self-pay accounts and private pay accounts.

  • Balance posted payments to the actual bank deposits on a monthly basis.

  • Meet established daily, weekly, monthly and annual deadlines.

  • Stay abreast of coding changes and updates to reimbursement guidelines per EOB explanations and inform Manager of Revenue Cycle Management of trends and changes.

  • Manage and maintain relationships with all payors to improve patient revenue.

  • Uphold Medicare, Medicaid, and HIPAA compliance guidelines in relation to billing, collections, and PHI information.

  • Follow written and verbal instructions from the Manager of Revenue Cycle Management.

  • Exhibit professionalism in communication with patients, clients, insurance companies and co-workers.

  • Participate in special projects.

  • Support Variety Care’s accreditation as a Patient-Centered Medical Home and our commitment to provide care to all Variety patients that is Safe, Effective, Patient-Centered, Timely, Efficient, and Equitable. Provide leadership and work with all staff to achieve the goals of the “Triple Aim” of healthcare reform—to improve the experience of care, improve health outcomes, and decrease healthcare costs.

  • Embodies the strength of personal character. Places value on being an open and honest communicator who displays high moral and ethical conduct, integrity, adaptability, and sound judgment. Must be a leader in the department and community. Result-oriented problem solver who is responsible and accountable.

  • Performs other duties as assigned.

Requirements, Special Skills or Knowledge:

  • High School diploma or GED. Associate's degree highly preferred or equivalent combination of experience and education.

  • Three to five years medical payment posting experience required.

  • Prior medical billing and insurance collections or healthcare revenue cycle experience including diversified experience with payers, managed care contracts, and payer methodology is required.

  • Working knowledge of CPT codes.

  • Understanding of medical terminology and protocols as well as basic knowledge of coding and anatomy are required.

  • Demonstrated mastery of critical thinking, analytics, problem-solving and sound decision-making skills required.

  • Demonstrated ability to interact and communicate effectively with individuals at various levels both inside and outside the organization, often in sensitive situations.

  • Proficiency and clerical accuracy with Microsoft Office and practice management software systems.

  • Professionalism, integrity, responsibility and dependability.

  • Ability to assist and support others in a professional and respectful manner.

ADA Requirements:

  • Must be able to lift and/or move up to 25 pounds.

  • While performing the duties of this job, the employee is frequently required to sit, stand, walk and talk.

  • Frequently required to bend and reach to fulfill job duties.

Job ID: 2021-2157

External Company Name: Variety Care, Inc.

External Company URL: http://www.varietycare.org/

Street: 3000 North Grand Blvd