Payment Specialist, Credits and Adjustments

Candidates must live in Ohio and be available for work in our Westerville, OH location. Position is eligible for remote/onsite hybrid work arrangement after completion of a 90-day introductory period.

Position Summary: Responsible for the expedient and accurate posting of adjustments and reconciliation of payments received.

Responsibilities/Accountabilities:

Payment Entry:

1. Completes adjustment entry and credits reconciliation in a timely and accurate manner including:
   1. Posts approved adjustments to practice management system to maintain reconciliation of accounts.
   2. Research adjustments to ensure accounts were appealed and worked in accordance with A/R policies and procedures.
   3. Balances batches, ensuring small balance and bad debt accounts have been appropriately worked, and initiates transaction reports.
   4. Ensures all cash, checks, EFT and credit card payments are reconciled and balanced between EMR and bank deposits daily. Identifies and resolves any transaction exceptions to ensure accurate daily balance.
   5. Reconciles and researches all credit balances and unapplied payments on accounts. Follows payer guidelines for notifications of overpayments on accounts.
   6. Ensures all A/R Adjustments and Credit Balances have been posted and balanced by month end.
   7. Post proper adjustments and payments for bad debt collection payments.

1. Properly communicates and documents payment denials in the practice management system and communicates with the appropriate billing representative in a timely manner.
2. Properly identifies insurance credit balances and overpayments by utilizing various software variance tools.
3. Completes ancillary payment posting reports as needed (low balance accounts, unapplied payments and unbalanced insurance accounts.)
4. Completes daily payment posting and reconciliation of unapplied payments on accounts to ensure accounts balance properly.
5. Research payer takebacks and recoupments to ensure accuracy of take back.
6. Processes patient refunds per department policy guidelines.
7. Completes assigned work queues daily. Ensuring response is according to status assigned (1 Normal - Respond within 3 days, 2 Priority - Respond within 2 days, 3 Urgent - Respond within 1 day).

Department Coverage:

1. Cross trained to provide department coverage in charge entry, posting payments/denials, lockbox postings and cash out.
2. Maintains professional knowledge regarding medical billing and coding procedures, insurance carriers, federal programs, and established payment posting workflows, etc.

Customer Service and Communications:

1. Communicates with patients, insurance carriers and other outside entities in a professional manner as needed. Identifies solutions and responds professionally to patient concerns, i.e., pleasant tone of voice, courteous language, etc. Uses appropriate grammar and demonstrates tact and diplomacy in patient interactions, by phone and in person.
2. Diffuses negative situations with patients and maintains a pleasant and professional tone during stressful circumstances and heavy workload.
3. Communicates with staff members in a professional, pleasant manner; Shares information relevant to work, no gossiping or disparaging remarks, accepts work without complaint or provides reasons why assignment is unmanageable, asks and answers questions related to improving department performance.

Teamwork:

1. Works cooperatively with coworkers, providers, and management.
2. Shares knowledge and insights with co-workers in a constructive manner.
3. Willingly provides coverage to department, staying beyond scheduled ending time when clinic schedule demands it, volunteering to cover time off or unexpected absences, maintaining workflow in department without direct supervision.
4. Addresses conflicts with person directly before involving manager or uninvolved peers.
5. Is considerate of others with regard to taking breaks or meal periods, use of computer and telephone, and noise in department.

Policies and Procedures:

1. Knows and complies with policies and procedures as enumerated in the Orthopedic One Employee Handbook and policies and procedures documents.
2. Provides assistance and support to leadership in implementing policies and procedures as necessary.
3. Actively participates in training, and conducting day to day work activity by adhering to all policies and procedures as enumerated in compliance and risk management programs.

Education, Experience, and Certification/Licensure Required:

High School Diploma or equivalent required with a minimum of two years of medical billing, bookkeeping, banking or finance experience. Certified Professional Coding education or certification is preferred. Candidates must be able to work with high volume of work while maintaining attention to detail and accuracy and demonstrate excellent oral and written communication skills. Computer skills required to operate practice management system (i.e., use Window operating system, conduct Internet searches, communicate by email, etc.).