Remittance and Payment Processor

Job Description

Job Description

About FCHC:

Since 1976, Florida Community Health Centers, Inc. (FCHC) has been a health care leader in Florida. We provide comprehensive primary and specialty health care and patient support services through a network of Centers surrounding Lake Okeechobee and across Florida’s Treasure Coast. Our mission is to ensure that everyone in our communities has access to culturally competent, high-quality health care that they can afford. FCHC has locations in Clewiston, Moore Haven, Okeechobee, Fort Pierce, Port St. Lucie, Stuart, Indiantown, Pahokee and West Palm Beach. FCHC’s Corporate Office is centrally located in West Palm Beach, Florida. FCHC has multiple staff members who speak Spanish and Creole, and translation is available for other languages as needed. FCHC has created a “one-stop shop” for patients–providing Pediatric and Adult Primary Care, Dental, OB/GYN and Women’s Health, Infectious Disease, Behavioral Health, Pharmacy, chronic disease education and care management, referral assistance, benefit enrollment assistance and coordination, and telehealth services. Our patients benefit from a “medical home” model, where they may access our extensive array of health care clinicians and services in an atmosphere where they are treated with respect, care, and concern.

Mission

The Mission of Florida Community Health Centers, Inc. (FCHC) is to provide accessible, cost-effective, high-quality, comprehensive health care to all persons in our communities.

Vision

Florida Community Health Centers, Inc. (FCHC) will maintain strong leadership in, and advocate for, the provision of health care services.

FCHC will foster and promote collaborative relationships and will develop partnerships with local, state, and federal public health service agencies and the community in general, to enhance the quality of delivery systems for comprehensive health care. FCHC will be an employer of choice and will demonstrate excellence with a highly trained staff and governing board.

Values

FCHC values Integrity, Compassion, Commitment to serving others (external and internal to the organization), Innovation, Effectiveness (cost and outcome), Efficiency, being Mission-driven, Commitment to serving others internal to organization and Commitment to Excellence.

Position Summary: The Payment Posting and Reconciliation Specialist is an important role in the Revenue Cycle Management area. It is an ideal position for someone seeking a high-impact individual contributor role, working both inside the payment posting systems as well as monitoring key interfaces. This is a great opportunity for someone seeking professional growth inside critical Finance and Revenue Cycle Management processes.

Primary Duties:
Third-Party Payment Management Responsibilities

• Along with the Director of Revenue Cycle Management, maintain a master listing of payment methods by payer, third-party administrators and plans.
• Periodically report the number and percentage of third-party organizations who remit via EFT compared to paper checks and credit card payments that require manual input

Clearinghouse Administration Responsibilities

• Monitor and report on Epic charge and claim exchange activity, highlighting charges that get held-up in clearinghouse filters.
• With the assistance of the Director of Revenue Cycle Management, prepare periodic summary of root cause(s) and action steps required to both address the charges held at the clearinghouse level as well as periodically reporting recommendation(s) to the Director of Revenue Cycle Management, Controller and CFO, for preventing similar “holds” in the future.

Financial Reporting (Revenue) Reporting Responsibilities

• Update the monthly Medicaid wrap tracking spreadsheet and distribute to the Senior Staff Accountant, Controller and CFO
• Update the monthly capitation payment tracking spreadsheet and distribute to the Senior Staff Accountant, Controller and CFO
• Provide the Senior Staff Accountant with support for credit adjustments posted each month by the payment posters (Epic Slicer-Dicer query that highlights credit adjustment codes)

Collaboration with Finance Department: Treasury Function

• Participate in Epic Cash Management Module implementation team
• With input from HCN and assistance from the Controller and Director of Revenue Cycle Management, draft and maintain as current Cash Management Module SOPs
• Utilize the Epic Cash Management Module in EPIC to reconcile cash receipts to payments posted and EOB support submitted for payments received.
• Collaborate with the FCHC Staff Accountant who prepares FCHC’s Bank Account Reconciliations to ensure the Epic Cash Management Module bank cut-off reconciliation is maintained
• Collaborate with the FCHC Staff Accountant to ensure all third party payer receipts received via EFTs, credit card, physical deposit and remote deposit, and in all bank accounts and for in-scope and out-of-scope services is accounted for

Payment Posting Responsibilities

• Post and balance remittance payments and adjustments, daily
• Match EFT receipts recorded in Availity to Epic payment postings by check number or amount and capture in batch, daily.
• Scan support for all third party payments not received via EFT (that is, received in the mail at the FCHC corporate office) and post manually in EPICdaily.
• Monitor Right Fax for Insurance Credit Card Payments and post manually in EPIC
• Copy insurance EOB’s for secondary payers and denials requiring additional information and submit daily to biller. Maintain original third party EOB’s by date.
• Upload all EOBs obtained from third-party sites and not available in the clearinghouse into Epic
• With the assistance of the Director of Revenue Cycle Management, use Epic Slicer-Dicer to report on unplanned credit adjustments (as noted during the payment posting process)
• Document reason for non-posting of payments received return to accounting for G/L coding & follow-up (i.e. bad recovery, payment not ours, etc.) on balancing worksheet, daily.
• Research and prepare refund requests for overpayments on all accounts that incur a credit balance at the time of payment posting.
• Update system notes for payments received on balances at the collection agency, forward to collector to report these payments to the Collection Agency.
• Ensure Medicaid wrap payments are posted in Epic in a timely manner
• Monitor and correct all items in the following Epic PBL workqueues: ___________________
• Log Medicare bad debt recoveries as received for inclusion in the Cost Report.
• With assistance from the Director of Revenue Cycle Management, periodically report on the status of any payer claw backs identified as a result of analyzing payments

Payer Website Access Management Responsibilities

• Along with the Director of Revenue Cycle Management, maintain a master listing of payer & third-party administrator website access login & passwords
• Provide support to other FCHC Finance and RCM team members who need access to payer & third-party administrator websites to research unpaid claims, payer claw backs
• Pull down capitated plan rosters each month, reconcile to capitation payments received and share copies of rosters in the designated shared drive for other FCHC employees to access
• Provide feedback to Director of Revenue Cycle Management on the consistency and accuracy of Epic payment and credit or adjustment codes, so that changes can be shared with HCN

OTHER RESPONSIBILITIES:

• Assist staff in answering patient and employee phone inquiries.
• Perform other charge or claim payment research, as directed by the Director of Revenue Cycle Management
• Assist the Director of Revenue Cycle Management develop SOPs as it relates to reconciling payments from “out-of-scope” services

QUALIFICATION & EDUCATION REQUIREMENTS:

• High School Diploma
• One (1) year experience handling medical claims processing
• Strong analytical skills including the ability to maintain inter-system reconciliations
• Good telephone etiquette and organizational skills
• Must be computer literate and have the aptitude to learn how to navigate Epic & a multitude of third-party websites.

Additional Notes:

All qualified candidates must be able to perform the essential functions of this position. This job description is not intended to be all-inclusive. FCHC reserves the right to modify or change the essential functions of this position based on reasonable related business necessity as assigned by your supervisor.

**This job description does not constitute a written or implied contract of employment**.

Our mission here at Florida Community Health Centers, Inc. is to provide accessible, cost-effective, high-quality, comprehensive health care to ALL persons in our communities. We serve 16 locations surrounding Lake Okeechobee & the Treasure Coast. Should you be interested please submit your resume to us for review. Thank you!

Company Description

Our mission here at Florida Community Health Centers, Inc. is to provide accessible, cost-effective, high-quality, comprehensive health care to ALL persons in our communities. We serve 16 locations surrounding Lake Okeechobee & the Treasure Coast. Should you be interested please submit your resume to us for review. Thank you!