Payment and Reconciliation Specialist- Hybrid

Payment And Reconciliation Specialist

Healthcare Outcomes Performance Company is a vertically integrated musculoskeletal outcomes management company. HOPCo manages physician practices, hospital service lines, population health and value-based care programs, and musculoskeletal delivery networks.

HOPCo is the managing partner of Arizona-based entities, CORE Institute, Northern Arizona Orthopaedics, CORE Institute Specialty Hospital, Michigan-based CORE Institute, and Florida-based Southeast Orthopedic Specialists.

As HOPCo continues to grow, we are looking for a Payment and Reconciliation Specialist in our Corporate Headquarters.

Essential Functions:

• Has an understanding of accounts receivable posting process for medical billing including: charges, payments and adjustments.
• 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 remittance files into patient account system ensuring file reconciliation including reviewing and posting exception files.
• Participation in optimizing productivity within area.
• Maintains knowledge of the work area and optimizes use of available technology.
• Researches all information needed to process and complete insurance and/or patient refunds by obtaining information from providers, insurance plans, ancillary services staff and patients.
• Accurately processes insurance and patient refunds requests by demonstrating an advanced understanding of coordination of benefits and eligibility requirements.
• Receives and processes all refunds utilizing insurance contracts and requirements for accuracy.
• Processes and posts refund checks as received into the patient accounting system.
• Establishes and maintains effective communication with physicians, staff and other departments as required. Other duties as assigned by leadership.
• Adheres and understands the Business Office rules and regulations in regards to Medicare and HIPAA guidelines.
• Effectively forwards accounts requiring work up or resubmission to the business office staff.
• Maintains productivity and accuracy metrics per department expectations and AEIOU Behavioral Standards

The job holder must demonstrate current competencies for job position.

Education:

• High school diploma/GED

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 with Physicians, patients and the public 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 Centricity patient management system preferred.
• Knowledge of policies and procedures with regards to physician billing processes including determining insurance eligibility and coordination of benefits.

Skills:

• Skill in customer service and an understanding of The CORE 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 prepare postings and reconcile daily receipts.
• Ability to communicate clearly and effectively.
• Ability to type minimum 40 wpm.

Environmental/Working Conditions:

• Normal office environment. Some travel within community.

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 read and signed.

Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

Southeast Orthopedic Specialists