Payments Specialist

Payments Specialist

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:

• 13 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