BILLING AND PAYMENT RESOLUTION SPECIALIST

PSN Services LLC•Plano, TX

About The Position

We are seeking an experienced Billing and Payment Resolution Specialist to join our revenue cycle team supporting surgical hospital and ambulatory surgery center (ASC) operations. This critical role involves overseeing billing charges, ensuring seamless claims transmission to clearinghouses and payors, performing accurate payment posting, and resolving payment discrepancies. The successful candidate will collaborate with our early out program leader to ensure optimal revenue cycle operations. The ideal candidate will possess advanced proficiency in CPSI/TruBridge, HST Pathways, and professional-level experience with Waystar revenue cycle management systems.

Requirements

Strong analytical and problem-solving abilities
Excellent attention to detail and accuracy
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; Associate's degree in Health Information Management, Healthcare Administration, or related field preferred
Current certification required: CPB (Certified Professional Biller) from AAPC or CRCR (Certified Revenue Cycle Representative) from HFMA
Minimum 3-5 years of healthcare billing experience with surgical hospital and/or ASC environments
Demonstrated professional-level experience with Waystar revenue cycle management platform
Proven experience in denial management and payment resolution
Experience with multiple payer types including commercial, Medicare, and Medicaid
Advanced proficiency in healthcare revenue cycle management systems
Strong knowledge of medical coding (CPT, ICD-10, HCPCS)

Nice To Haves

CPC (Certified Professional Coder) certification preferred
Knowledge of CPSI/TruBridge systems preferred
Experience with HST Pathways ASC software preferred

Responsibilities

Review and validate billing charges for accuracy, completeness, and compliance with coding guidelines and payer requirements
Ensure timely and accurate charge capture for all surgical procedures and related services
Monitor charge lag reports and collaborate with clinical staff to resolve missing or incomplete charges
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, Medicaid)
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
Communicate with insurance companies for basic claim status inquiries and routine payment issues
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