Overview:
The Revenue Cycle Specialist, Payments & Remittance will be responsible for accurately posting and reconciling insurance payments into the practice management system, ensuring all transactions are recorded in compliance with contractual and regulatory guidelines. This role requires strong attention to detail, the ability to work across multiple systems, and a commitment to meeting accuracy and productivity benchmarks.
This is a 100% remote position.
Responsibilities:
- Accurately post all insurance payments, adjustments, and denials to client accounts in an accurate and timely manner.
- Review and reconcile check deposits, EFTs, and lockbox reports to ensure completeness and accuracy of payment posting.
- Ensure all payments are posted in accordance with payer contracts and client-specific rules.
- Maintain a high level of productivity while meeting quality standards (99%+ accuracy).
- Ensure all payments show matched and reconciled on the Reconciliation Report, entering notes indicating reasoning for non-match on all discrepancies
- Manage the Zentist portal daily to mark payments as posted and ensure the daily deposit is complete.
- Assign denied claims to denial management and AR teams within Denticon’s task manager to ensure proper handling of underpayments
- Monitor and process Electronic Remittance Advice (ERA) in DentalxChange
- Resolve all payments with missing Explanation of Benefits (EOB)
- Acquire Electronic Remittance Advice (ERA)/ Explanation of Benefits (EOB) files from multiple sources including but not limited to DentalxChange, Zentist, Payor Portals, phone calls to payors
- Escalate recurring payer issues or payment variances to Revenue Cycle Manager for resolution.
- Maintain status reporting of workload on Daily Tracker for payment & denial posting, reconciliation and ERA processing for assigned practices
- Pre-Audit and escalate fee discrepancies to the fees team
- Initiates refund tickets of received overpayments requests from payors
- Adhere to HIPAA guidelines and internal compliance protocols.
Performance Metrics (KPIs):
- Productivity - Consistently post 30+ payments/adjustments per hour worked. Auto-posted payments are included in productivity totals.
- Accuracy - Maintain a minimum accuracy rate of 99% for all posting activities.
- Timeliness - Manual Posting: Ensure all manual payment postings are completed within 2 business days of receipt.
- Timeliness - ERA Reconciliation: Complete ERA auto-posting reconciliation within 5 business days of posting
Work Environment:
- This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
- Physical Demands:
- The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
- While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms.
- This position requires the ability to occasionally lift products and supplies, up to 20 pounds.
Competencies:
- Quality of Work – Consistently produces acceptable quality of work and only requires a reasonable amount of supervision.
- Initiative – Demonstrates a strong work ethic. Takes the appropriate risks and focuses on outcomes. Needs only a reasonable level of supervision.
- Communication – Demonstrates effective listening skills. Maintains eye contact. Focuses on content. Is thoughtful and articulate when speaking with others. Has good written and oral communication skills.
- Customer Service – Is attentive and responsive to the needs of others. Handles difficult situations with patience, tact and grace. Accurately identifies and anticipates needs. Flexible with making adjustments in service delivery.
- Punctuality/Time Management – Is reliable and punctual to work and all meetings, functions and training. Fulfills commitments on time that contribute to team goals.
- Ensures Accountability – Holds self and others accountable to meet commitments.
- Action Oriented – Taking on new opportunities and touch challenges with a sense of urgency, high energy and enthusiasm.
- Collaborates – Building partnerships and working collaboratively with others to meet shared objectives. Partners with others to get work done. Gains trust and support of others.
Qualifications:
High School Diploma or Equivalent Required
Associate’s Degree in Business Administration, Economics or related field strongly preferred
Qualifications/Training:
- Three (3) years previous buying experience strongly preferred, or ability to demonstrate comparable combination of knowledge and skill
- Ability to exercise independent judgement
- Excellent written and verbal communication skills
- Demonstrates aptitude in effective negotiating
- Familiarity with market research, data analysis and forecasting techniques
Legal Disclaimer:
We comply with all minimum wage laws as applicable. All benefits are subject to potential vesting and eligibility requirements. The company is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, ancestry, color, age, national origin, ethnicity, religious creed or belief, physical or mental disability, marital or familial status, legally protected medical condition, genetic information, military or veteran status, sex, gender, sexual orientation, citizenship status, or any other characteristic protected by applicable law.
