Payment Researcher
1 week ago
Key Responsibilities:
- Manage all aspects of payment postings within the A/R system.
- Interpret payer Explanation of Benefits (EOBs), including patient responsibilities, contractual adjustments, interest amounts, and denial/remark codes.
- Identify and apply payments and retractions from various payers, using appropriate payment codes, source codes, and remark codes in the A/R system.
- Handle patient credit balances by processing refunds or transferring payments between hospital and professional accounts.
- Conduct payment research and cashiering functions as needed to support accurate financial reporting.
Requirements:
- High school diploma or GED; Minimum of 3 years of relevant experience, including at least 1 year in collections investigation.
- Experience in commercial and managed care collections, highly desired.
- Ability to interpret payer contracts and process contractual adjustments.
- In-depth knowledge of UB04 requirements and medical billing processes.
- Strong analytical skills and proven proficiency in Excel and spreadsheets.
- Understanding of collection techniques and laws, including AB1455, the Knox-Keene Act, Health & Safety Codes, etc.
- Familiarity with medical terminology, CPT codes, HCPCS codes, health networks, IPAs, HMOs, PPOs, PCPs, and contract affiliations.
- Excellent verbal and written communication skills.
- Proficiency in Microsoft Office, especially Excel and Word.
- Exceptional organizational skills, with the ability to meet deadlines, work independently or as part of a team, and prioritize tasks effectively.
About the Role:
This is an exciting opportunity to join the Academy of Managed Care Pharmacy as a Payment Researcher, supporting the accurate and efficient payment posting processes that ensure smooth revenue operations.
Under the direction of the Cash Posting Supervisor, you will be responsible for managing all aspects of payment postings within the A/R system, interpreting payer Explanation of Benefits (EOBs), and handling patient credit balances by processing refunds or transferring payments between hospital and professional accounts.
As a Payment Researcher, you will have the opportunity to work closely with the team to identify and apply payments and retractions from various payers, using appropriate payment codes, source codes, and remark codes in the A/R system.
Additionally, you will be conducting payment research and cashiering functions as needed to support accurate financial reporting.
Requirements:
- High school diploma or GED; Minimum of 3 years of relevant experience, including at least 1 year in collections investigation.
- Experience in commercial and managed care collections, highly desired.
- Ability to interpret payer contracts and process contractual adjustments.
- In-depth knowledge of UB04 requirements and medical billing processes.
- Strong analytical skills and proven proficiency in Excel and spreadsheets.
- Understanding of collection techniques and laws, including AB1455, the Knox-Keene Act, Health & Safety Codes, etc.
- Familiarity with medical terminology, CPT codes, HCPCS codes, health networks, IPAs, HMOs, PPOs, PCPs, and contract affiliations.
- Excellent verbal and written communication skills.
- Proficiency in Microsoft Office, especially Excel and Word.
- Exceptional organizational skills, with the ability to meet deadlines, work independently or as part of a team, and prioritize tasks effectively.
Salary Range: $26.79-$38.05/hourly
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