Overview
The Revenue Cycle Specialist, Payments & Remittance is responsible for accurately posting and reconciling insurance payments within the practice management system. This role ensures all transactions comply with contractual and regulatory guidelines, requiring strong attention to detail, proficiency with multiple systems, and adherence to accuracy and productivity standards. This position is 100% remote.
Responsibilities
- Post insurance payments, adjustments, and denials to client accounts accurately and timely.
- Review and reconcile check deposits, EFTs, and lockbox reports to verify payment posting completeness and accuracy.
- Ensure payment postings comply with payer contracts and client-specific rules.
- Maintain productivity while achieving quality standards of 99%+ accuracy.
- Match and reconcile all payments on the Reconciliation Report, documenting reasons for any discrepancies.
- Manage the Zentist portal daily to mark payments as posted and confirm daily deposits.
- Assign denied claims to denial management and accounts receivable teams using Denticon’s task manager.
- Monitor and process Electronic Remittance Advice (ERA) in DentalxChange.
- Resolve payments missing Explanation of Benefits (EOB).
- Obtain ERA/EOB files from multiple sources including DentalxChange, Zentist, payer portals, and direct communication with payers.
- Escalate recurring payer issues or payment variances to the Revenue Cycle Manager.
- Maintain workload status reporting on the Daily Tracker for payment and denial posting, reconciliation, and ERA processing.
- Pre-audit and escalate fee discrepancies to the fees team.
- Initiate refund tickets for overpayment requests received from payers.
- Adhere to HIPAA guidelines and internal compliance protocols.
Performance Metrics (KPIs)
- Productivity: Post 30+ payments/adjustments per hour worked, including auto-posted payments.
- Accuracy: Maintain a minimum 99% accuracy rate for all posting activities.
- Timeliness: Complete manual payment postings within 2 business days of receipt.
- Timeliness: Complete ERA auto-posting reconciliation within 5 business days of posting.
Work Environment
- Operates in a professional office environment using standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines.
- Physical demands include regular talking and hearing, frequent standing, walking, using hands to finger, handle or feel, and reaching with hands and arms.
- Occasionally required to lift products and supplies up to 20 pounds.
Competencies
- Quality of Work: Produces acceptable quality work with minimal supervision.
- Initiative: Demonstrates strong work ethic, takes appropriate risks, and focuses on outcomes.
- Communication: Effective listening skills, thoughtful and articulate verbal and written communication.
- Customer Service: Attentive and responsive, handles difficult situations with patience and tact.
- Punctuality/Time Management: Reliable and punctual, meets commitments on time.
- Accountability: Holds self and others accountable to meet commitments.
- Action Oriented: Approaches challenges with urgency, energy, and enthusiasm.
- Collaboration: Builds partnerships and works collaboratively to meet shared objectives.
Qualifications
- High School Diploma or Equivalent required.
- Associate’s Degree in Business Administration, Economics, or related field strongly preferred.
Experience and Skills
- Three (3) years of previous buying experience strongly preferred or equivalent combination of knowledge and skill.
- Ability to exercise independent judgment.
- Excellent written and verbal communication skills.
- Aptitude in effective negotiating.
- Familiarity with market research, data analysis, and forecasting techniques.
Legal and Compliance
The employer complies with all applicable minimum wage laws. Benefits are subject to vesting and eligibility requirements. Equal Employment Opportunity is provided to all qualified applicants without regard to race, ancestry, color, age, national origin, ethnicity, religious creed or belief, physical or mental disability, marital or familial status, legally protected medical condition, genetic information, military or veteran status, sex, gender, sexual orientation, citizenship status, or any other characteristic protected by law.