Payment Specialist

Overview

This role involves managing the end-to-end payment process for a specialty care management organization focused on complex injuries and diagnoses. The Payment Specialist ensures accuracy, compliance, and timely disbursement of funds to external vendors and providers. The position requires independent judgment to resolve complex payment issues, advanced analysis of payment trends, and leadership in process improvement initiatives. The specialist acts as a subject matter expert and key liaison across internal teams and external partners to enhance operational efficiency and payment accuracy.

Responsibilities

• Prepare, audit, and generate complex payment files for submission to payment vendors according to schedules, client requirements, and regulatory guidelines
• Validate payment file accuracy through detailed review of payment data, provider information, offsets, adjustments, and reconciliation balancing
• Submit payment files via designated vendor platforms and ensure successful transmission, receipt, and processing
• Monitor payment submissions for rejections, exceptions, or errors and take corrective action to prevent delays
• Perform detailed reconciliations between vendor platforms, internal systems, bank reporting, and payment batches
• Research, analyze, troubleshoot, and resolve payment file discrepancies, balancing issues, and processing errors promptly
• Serve as a subject matter resource and liaison for provider payment release requests, escalated inquiries, and payment status investigations
• Process payment reissues, voids, stop payments, recoupments, and offsets per department procedures and compliance standards
• Create and validate client refund files for Accounting processing and reconciliation
• Collaborate cross-functionally with internal departments, external vendors, banking partners, and IT to resolve discrepancies, transmission failures, and file format issues
• Maintain detailed documentation and audit-ready records of payment submissions, corrections, reconciliations, approvals, and outcomes
• Analyze payment activity trends and provide reports on payment accuracy, aging, rejection trends, reconciliation findings, and resolution timelines
• Identify operational risks, process inefficiencies, and recurring payment issues; recommend process improvements to enhance accuracy and reduce rework
• Support revenue cycle operations through accurate and timely disbursement processing while ensuring adherence to client contracts and service levels
• Generate, analyze, and reconcile reports from Data Warehouse and applicable systems to identify Provider Accounts Payable due and outstanding payment activity
• Reconcile payment acknowledgement reports against payment batch files to identify invoices requiring voids, corrections, or reprocessing
• Generate Explanation of Reimbursement (EOR) documentation and coordinate distribution
• Manage and prioritize the AP queue for provider payment requests, escalations, research items, and inquiries while maintaining service expectations
• Generate and review outstanding AP reports with management and assist in identifying trends, risks, and resolution strategies
• Assist with departmental audits, special projects, workflow enhancements, system testing, and implementation initiatives
• Provide support and training to team members on payment processing workflows, reconciliation procedures, and issue resolution
• Maintain confidentiality and safeguard sensitive financial, provider, and client information in compliance with policies and regulations
• Maintain reliable and predictable attendance during scheduled work hours
• Utilize AI tools to support daily tasks, improve efficiency, and enhance output quality; adopt new technologies as trained and apply them according to established processes

Requirements

• Acute attention to detail
• Understanding of medical billing, short payments, and denials
• Experience with reconciliation between various systems
• Strong interpersonal skills
• Ability to communicate professionally and effectively via phone, in person, electronically, or other means
• Ability to interact effectively with individuals at all organizational levels
• Proven ability to manage multiple projects and meet deadlines
• Ability to read and comprehend instructions, correspondence, memos, and documentation
• Commitment to excellence and high standards
• Ability to work independently and collaboratively within teams and committees
• Proficiency in English (speaking, reading, writing, and understanding)
• Advanced knowledge of Microsoft Excel and familiarity with Microsoft Access

Preferred Qualifications

• Experience in specialty care or value-based care payment environments is beneficial but not explicitly required

Compensation & Benefits

• Health insurance options including PPO, HDHP, and HMO plans (Cigna and Kaiser for California employees)
• Competitive salaries
• 401(k) matching contributions
• Employer-paid life and disability insurance
• Flexible spending and commuter accounts
• Employer-matched Health Savings Account (HSA) contributions
• Paid time off and personal holiday programs
• One paid volunteer day per calendar year for full and part-time employees
• Learning and development opportunities to support continuous growth

Location

• Not specified

Additional Information

• The organization complies with federal and state disability laws and provides reasonable accommodations for applicants and employees with disabilities.
• Equal Opportunity Employer: does not discriminate based on race, color, sex, age, national origin, religion, sexual orientation, gender identity, veteran status, disability, or any other protected class.
• As a contractor with the State of Wisconsin, the organization complies with Wisconsin Contract Compliance Law (16.765).