Payment Application Specialist

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Responsible for posting insurance and/or patient payments to Epic and balancing those postings to the bank deposits in a timely and accurate manner. Posting can include electronic processing of remittance posting files or manually posting payments from a paper remittance. Assists Departmental Coordinator in researching and resolving outstanding deposits and unidentified or missing payments.

Minimum Qualifications

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

• High School Graduate or equivalent.

Experience

PREFERRED QUALIFICATIONS:

• One (1) year medical billing/medical office experience preferred.
• Bookkeeping and cash balancing experience.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

• Processes electronic remittances initiating transaction posting in Epic.
• Works transactions that do not post correctly to ensure that transactions route to the appropriate accounts.
• Identifies any unidentified payment transactions that route to the clearing account, following facility processes to move non-patient money to correct general ledger account.
• Balances postings to bank deposits utilizing provided technical tools in Epic and via Microsoft Excel.
• Maintains timely and accurate posting according to departmental goals and report to management.
• Documents accounts clearly and accurately.
• Analyzes and reconciles posting amounts from patient payment and other sources of payment (non-accounts receivable (AR) cash) to the patient accounting system and accounting department.
• Uses system software, including online credit card systems and the Epic system.
• Creates, enters, and assigns cash management batches.
• Opens and distributes mail received from the post office and financial institutions for the various entities services are billed for
• Contacts the appropriate third party payors, business entities, or financial institutions to resolve unidentified or missing payments.
• Accesses any scanned information via One Content imaging system.
• Completes and reconciles bank deposits daily.
• Utilizes remittance work queues to resolve payment errors.
• Reviews and reconciles all postings monthly with the Departmental Coordinator as needed.
• Participates in educational programs to meet mandatory requirements and identified needs with regard to job and personal growth.
• Researches accounts in work queues with credit or undistributed self-pay balances, and works to resolve these balances by distributing to other outstanding account, refunding another approved facility, or refunding the guarantor.
• Investigates insurance overpayments and takes appropriate action from within the work queue to resolve the variance.
• Processes refund requests received from third party payors, clinical departments, other areas of Revenue Cycle, and leadership.
• Monitors accounts that fall within out special billing guidelines (i.e. cosmetic, bariatric, IVF, plastics, etc.) to insure pre- payment application is done within a timely manner.
• Works with the appropriate accountants to maintain a list of all unclaimed property, and maintain a spreadsheet for submission to the state.
• Takes calls from registration and customer service staff experiencing issues with cash drawers, and works to resolve the issues.
• Insures all refund requests are received from accounts payable, and processes the checks for submission to third party or guarantor.
• Maintains current knowledge of payor payment provisions and all local, state, and federal collection laws.
• Contacts insurance company or employer to determine eligibility, benefits, and payment information necessary to refund or distribute payments
• Ability to accurately utilize payor portals to initiate overpayment recoveries
• Identifies missing charges and communicates with appropriate coding manager for re-entry
• Completes reports assigned by Revenue Cycle leadership for bulk refunds to third party payors.
• Monitors work queue for inappropriate hospital payments posted to professional billing, and works with appropriate entity for posting.
• Assists hospital cashier’s office in locating and resolving missing receipts.
• Aids accounting department in reconciling patient payments for the entity in which the receipt was deposited.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to sit for extended periods of time.
• Must have reading and comprehension ability.
• Visual acuity must be within normal range.
• Must have manual dexterity to operate keyboards, fax machines, telephones and other business equipment.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Office type environment.

Skills And Abilities

• Excellent oral and written communication skills.
• Knowledge of medical terminology preferred.
• Knowledge of third party payers preferred.
• Knowledge of business math preferred.
• Knowledge of ICD-10 and CPT coding processes preferred.
• Excellent customer service and telephone etiquette.
• Ability to use tact and diplomacy in dealing with others.
• Knowledge of patient accounting principles and procedures.
• Working knowledge of computers.
• Maintains knowledge of current online banking systems.

Additional Job Description

Scheduled Weekly Hours:

40

Exempt/Non-Exempt

Shift:

United States of America (Non-Exempt)

Company

SYSTEM West Virginia University Health System

Cost Center

544 UHA Patient Financial Services