Payment Audit & Contractual Adjustment Specialist

Advanced Rx Management•Sunrise, FL

About The Position

We are seeking a detail-oriented and analytical Payment Audit & Contractual Adjustment Specialist to oversee the accuracy of posted payments and ensure account balances are properly resolved before accounts reach the Collections Department. In this role, you will audit payments previously posted by the Payment Posting Team, cross-reference payer contracts and reimbursement agreements, and apply accurate contractual allowances and adjustments directly to account ledgers. The primary objective of this position is to identify and correct payment posting discrepancies, ensure contractual adjustments are accurately applied, reduce outstanding and unresolved balances, and minimize manual intervention by the Collections Department while supporting timely and accurate cash flow reconciliation. The ideal candidate will have a strong knowledge of healthcare revenue cycle management, insurance reimbursement practices, EOBs/ERAs, payment posting, contractual adjustments, and account reconciliation.

Requirements

Strong understanding of healthcare revenue cycle management and payment posting workflows.
Knowledge of EOBs, ERAs, payer remittances, contractual allowances, write-offs, patient responsibility, and account reconciliation.
Knowledge of HIPAA and confidentiality requirement

Nice To Haves

Experience working in a healthcare billing, medical billing, pharmacy, physician, hospital, or other healthcare revenue cycle environment.
Experience auditing payment posting performed by offshore or third-party billing teams.
Experience working with payer contracts, fee schedules, reimbursement methodologies, and contractual allowances.
Experience with healthcare billing or practice management systems and electronic payment platforms.
Experience identifying insurance underpayments, incorrect contractual adjustments, and missed revenue opportunities.
2–4 years of relevant experience in medical billing, revenue cycle management, payment posting, payment auditing, accounts receivable, contractual adjustments, or healthcare account reconciliation.

Responsibilities

Audit payment postings completed by the Payment Posting Team to verify the accuracy of payment amounts, adjustments, patient responsibility, and account balances.
Compare posted payments against Explanation of Benefits (EOBs), Electronic Remittance Advice (ERAs), insurance correspondence, and other supporting documentation.
Identify discrepancies, misallocated payments, duplicate postings, missing payments, incorrect adjustments, and other posting errors.
Research and resolve payment discrepancies by reviewing account history, payer documentation, and supporting records.
Review payer contracts, fee schedules, reimbursement agreements, and applicable payment terms to determine appropriate contractual allowances and adjustments.
Calculate and apply accurate contractual adjustments and administrative adjustments to patient and insurance accounts.
Correct account ledgers to ensure balances accurately reflect payer reimbursement and contractual obligations.
Systematically resolve eligible accounts and balances in accordance with company policies and payer agreements.
Reconcile payment activity, contractual adjustments, and account balances to ensure accurate financial records.
Review account-level transactions and trace discrepancies to their source.
Research historical transactions and payment activities when necessary to determine the appropriate resolution.
Ensure accounts are properly balanced following payment posting and contractual adjustments.
Identify trends in unresolved balances and recommend process improvements to reduce recurring issues.
Coordinate with Payment Posting, Billing, Collections, and other departments to resolve account discrepancies.