Payment Audit & Contractual Adjustment Specialist

Job Description

Job Description

  Job Summary 

We are seeking a detail-oriented and analytical Payment Audit & Contractual Adjustment Specialist to oversee the accuracy of posted payments and ensure account balances are properly resolved before accounts reach the Collections Department. In this role, you will audit payments previously posted by the Payment Posting Team, cross-reference payer contracts and reimbursement agreements, and apply accurate contractual allowances and adjustments directly to account ledgers. 

The primary objective of this position is to identify and correct payment posting discrepancies, ensure contractual adjustments are accurately applied, reduce outstanding and unresolved balances, and minimize manual intervention by the Collections Department while supporting timely and accurate cash flow reconciliation. 

The ideal candidate will have a strong knowledge of healthcare revenue cycle management, insurance reimbursement practices, EOBs/ERAs, payment posting, contractual adjustments, and account reconciliation.

Key Responsibilities 

Payment Auditing & Quality Assurance 

• Audit payment postings completed by the Payment Posting Team to verify the accuracy of payment amounts, adjustments, patient responsibility, and account balances. 

• Compare posted payments against Explanation of Benefits (EOBs), Electronic Remittance Advice (ERAs), insurance correspondence, and other supporting documentation. 

• Identify discrepancies, misallocated payments, duplicate postings, missing payments, incorrect adjustments, and other posting errors. 
• Research and resolve payment discrepancies by reviewing account history, payer documentation, and supporting records. 

Contractual Adjustments & Ledger Resolution 

• Review payer contracts, fee schedules, reimbursement agreements, and applicable payment terms to determine appropriate contractual allowances and adjustments. 
• Calculate and apply accurate contractual adjustments and administrative adjustments to patient and insurance accounts. 
• Correct account ledgers to ensure balances accurately reflect payer reimbursement and contractual obligations. 
• Systematically resolve eligible accounts and balances in accordance with company policies and payer agreements. 

Account Reconciliation & Balance Resolution 

• Reconcile payment activity, contractual adjustments, and account balances to ensure accurate financial records. 

• Review account-level transactions and trace discrepancies to their source. 

• Research historical transactions and payment activities when necessary to determine the appropriate resolution. 

• Ensure accounts are properly balanced following payment posting and contractual adjustments. 

• Identify trends in unresolved balances and recommend process improvements to reduce recurring issues. 

• Coordinate with Payment Posting, Billing, Collections, and other departments to resolve account discrepancies. 

Preferred Qualifications 

• Experience working in a healthcare billing, medical billing, pharmacy, physician, hospital, or other healthcare revenue cycle environment. 

• Experience auditing payment posting performed by offshore or third-party billing teams. 

• Experience working with payer contracts, fee schedules, reimbursement methodologies, and contractual allowances. 
• Experience with healthcare billing or practice management systems and electronic payment platforms. 
• Experience identifying insurance underpayments, incorrect contractual adjustments, and missed revenue opportunities. 
• 2–4 years of relevant experience in medical billing, revenue cycle management, payment posting, payment auditing, accounts receivable, contractual adjustments, or healthcare account reconciliation. 

Skills, Knowledge & Abilities 

• Strong understanding of healthcare revenue cycle management and payment posting workflows. 
• Knowledge of EOBs, ERAs, payer remittances, contractual allowances, write-offs, patient responsibility, and account reconciliation. 
• Knowledge of HIPAA and confidentiality requirement 

Standard Specifications 

This job description describes the general nature and level of work and is not intended to be an exhaustive list of all duties, responsibilities, or requirements. Duties and responsibilities may change based on business needs. Employees may be assigned other job-related duties as needed. 

This description does not create an employment contract, express or implied, or alter an at-will employment relationship, where applicable. 

Equal Employment Opportunity 

Advanced Rx Management LLC is an Equal Employment Opportunity (EEO) employer. We are committed to providing equal employment opportunities to all qualified applicants and employees without regard to legally protected characteristics under applicable federal, state, or local law. We provide reasonable accommodation to qualified individuals with disabilities and for other legally protected needs, as required by applicable law