Medical Insurance Reconciliation and Payment Integrity Specialist :

Lee Obstetrics & Gynecology•Auburn, AL

1d•Onsite

About The Position

Our Medical Insurance Reconciliation Specialist is responsible for reconciling insurance payments and adjustments to ensure accurate posting, account balances, and financial records. This position reviews insurance remittances, identifies discrepancies, researches unpaid or incorrectly paid claims, and works with billing, insurance companies, and internal departments to resolve outstanding issues.

Requirements

High school diploma or equivalent required.
Knowledge of medical insurance terminology, EOBs, ERAs, CPT/ICD coding, and payer requirements.

Nice To Haves

Medical billing, insurance verification, payment posting, or revenue cycle experience preferred.
Experience with a medical practice preferred.
Experience with electronic medical records/practice management systems preferred.

Responsibilities

Reconcile daily, weekly, and monthly insurance payments against EOBs, ERAs, and payment reports.
Verify that insurance payments, contractual adjustments, denials, and patient responsibilities are posted accurately.
Identify discrepancies between expected reimbursement and actual insurance payments.
Review EOBs and ERAs for incorrect payments, underpayments, overpayments, recoupments, and takebacks.
Research and resolve unapplied or misapplied insurance payments.
Identify claims that were paid incorrectly or remain unpaid and coordinate appropriate follow-up.
Verify contractual allowances and ensure adjustments are posted according to payer contracts.
Review credit balances and determine whether balances are appropriate for refund, transfer, or correction.
Monitor insurance accounts for unusual or recurring payment discrepancies.
Research denied and partially paid claims.
Coordinate with insurance carriers regarding payment discrepancies, claim status, recoupments, and reimbursement issues.
Maintain accurate reconciliation logs and documentation of outstanding discrepancies.
Communicate discrepancies to management and make recommendations for correction.
Ensure all insurance transactions are posted to the correct patient account, payer, provider, and date of service.
Review payment batches to ensure deposits and system postings balance.
Assist with identifying trends in payer underpayments, denials, and reimbursement issues.
Work closely with Billing, Accounts Receivable, Payment Posting, and Collections to maintain clean accounts receivable.
Perform other duties related to insurance reconciliation and revenue cycle management as assigned.