BILLING AND PAYMENT RESOLUTION SPECIALIST

PSN Services LLC•Plano, TX

About The Position

Legent Health is seeking an experienced Billing and Payment Resolution Specialist to join their team, supporting high-volume imaging and physical therapy operations. This role is crucial for overseeing billing charges, ensuring claims are transmitted smoothly to clearinghouses and payors, accurately posting payments, and resolving any payment discrepancies. The specialist will collaborate with the early out program leader to optimize revenue cycle operations. The ideal candidate will have advanced proficiency in radiology and PT-focused billing platforms and professional-level experience in revenue cycle management.

Requirements

Strong analytical and problem-solving abilities.
Excellent attention to detail and accuracy.
Understanding of healthcare reimbursement methodologies including radiology fee schedules and therapy cap/KX modifier rules.
Effective written and verbal communication skills.
Ability to work independently and manage multiple priorities.
Customer service orientation for patient and payer interactions.
Understanding of healthcare reimbursement methodologies.
Knowledge of regulatory requirements affecting billing operations.
High school diploma or GED required.
Minimum 3-5 years of healthcare billing experience in high-volume imaging (radiology, MRI, CT, ultrasound) and/or physical/occupational therapy environments.
Demonstrated professional-level experience with Waystar revenue cycle management platform.
Experience with multiple payer types including commercial, Medicare, and Workers Comp.
Advanced proficiency in healthcare revenue cycle management systems.
Strong knowledge of medical coding (CPT, ICD-10, HCPCS).
Experience with electronic claim submission and clearinghouse operations.
Proficient in Microsoft Office Suite, particularly Excel for data analysis.
Ability to navigate multiple software systems simultaneously.
Experience with electronic remittance advice (ERA) processing.

Nice To Haves

Associate's degree in Health Information Management, Healthcare Administration, or related field preferred.
Current certification preferred: CPB (Certified Professional Biller) from AAPC or CRCR (Certified Revenue Cycle Representative) from HFMA.
Experience with HST Pathways software preferred.

Responsibilities

Review and validate billing charges for accuracy, completeness, and compliance with coding guidelines and payer requirements across high-volume imaging studies and physical/occupational therapy service lines.
Ensure timely and accurate charge capture for diagnostic imaging procedures (MRI, CT, X-ray, ultrasound) and therapy visit services.
Monitor charge lag reports and collaborate with clinical and front desk staff to resolve missing or incomplete charges in high-volume, multi-location environments.
Notify early out program leader of charge description master (CDM) updates and pricing discrepancies.
Perform daily charge reconciliation and exception reporting.
Submit claims electronically through clearinghouses to various payors (commercial, Medicare, Workers Comp).
Monitor claims transmission reports and resolve transmission errors.
Track claim status from submission through adjudication.
Manage claim edits, rejections, and clearinghouse error resolution.
Maintain clean claim rates above 98% through systematic pre-submission validation.
Post payments accurately from electronic remittance advice (ERA) and paper EOBs.
Reconcile daily cash receipts and identify payment variances.
Process contractual adjustments, write-offs, and refunds according to established procedures.
Maintain payment posting accuracy above 99%.
Generate and analyze payment reports for management review.
Handle claim rejections and edits at the clearinghouse level before transmission to payors.
Research and resolve payment discrepancies and short payments for routine claims.
Research and resolve unidentified payments from insurance and patient sources, coordinate with patient access and billing teams to locate appropriate accounts and ensure timely clearing of payment suspense items to support accurate month-end financial reporting.
Process initial claim corrections and resubmissions through clearinghouse systems.
Collaborate with AR specialist for high-level accounts receivable issues requiring advanced resolution.
Maintain detailed documentation of all front-end resolution activities.
Escalate complex denial patterns and unresolved payment issues to AR specialist.
Track and report rejection trends and initial resolution rates.