Payments Specialist

Job Description

Job Description

Description:

Position Summary:

The Payments Specialist is responsible for accurately posting, reconciling, and managing insurance payments for behavioral health providers. This role ensures that all revenue received from insurance as a direct result of Compass' billing efforts is accurately recorded and tracked. The Payments Specialist plays a key role in supporting the financial health of both Compass and its clients by maintaining clean payment data, identifying underpayments or missed revenue opportunities, and collaborating with third-party vendors to optimize reimbursement outcomes.

Essential Duties and Responsibilities:

• Accurately post and reconcile insurance payments and electronic remittances (ERAs)
• Review and interpret Explanation of Benefits (EOBs) to ensure correct allocation of payments and adjustments.
• Identify and escalate denied claims, underpayments, and payment discrepancies.
• Coordinate with third-party vendors to mitigate cost-containment impacts and support repricing workflows.
• Enter claim data into Compass’ workflow-management platform to support repricing and payment negotiation processes.
• Monitor for opportunities to recover additional revenue through rate negotiations and appeals.
• Maintain compliance with payer policies, HIPAA regulations, and internal documentation standards.
• Deliver accurate and timely reporting to internal stakeholders to support decision-making and operational alignment.
• Perform other duties as assigned by the Payments Supervisor or RCM Director.
• Qualifications:
• 1–3 years of experience in medical billing, payment posting, or healthcare revenue cycle management (behavioral health preferred).
• Familiarity with insurance reimbursement, claim processing, and third-party repricing vendors.
• Strong attention to detail, organization, and data accuracy.
• Proficiency with EHR systems, billing platforms, and Microsoft Office tools.
• Effective written and verbal communication skills.
• Strong critical thinking and problem-solving ability.
• Key Metrics:
• Payment Accuracy - Maintain accurate posting and reconciliation of payments with minimal errors or missed revenue.
• Discrepancy Resolution - Identify and escalate underpayments, denials, and issues with third-party vendors in a timely manner.
• Workflow Compliance - Enter claim and payment data into designated systems accurately and in accordance with department workflows.
• Reporting & Collaboration - Provide timely, reliable updates and data to internal teams and stakeholders.
• Vendor & Repricing Support - Assist in repricing and cost containment efforts by ensuring accurate and complete data entry