Medical Revenue Cycle - Payment Specialist

Paradigm•Tampa, FL

10d•$24 - $27•Remote

About The Position

The Payment Specialist supports Paradigm's Revenue Cycle operations by managing provider payment processes, resolving discrepancies, and ensuring financial accuracy. This role partners with internal teams and external stakeholders to drive operational efficiency, payment integrity, and exceptional service.

Requirements

Acute attention to detail
Understanding of medical billing, short payments and denials
Reconciliation between various systems
Strong interpersonal skills
Ability to communicate professionally and effectively on the phone, in person, electronically, or through other means to individuals and groups
Ability to deal effectively with individuals at all organizational levels
Proven ability to handle multiple projects while meeting deadlines
Ability to read and comprehend simple instructions, short correspondence, memos, and other documentation
Commitment to excellence and high standards
Ability to work independently and as a member of various teams and committees
Must be able to speak, read, write, and understand the primary language(s) used in the workplace: English
Technical Capacity including advanced knowledge of Microsoft Excel and familiarity with Microsoft Access

Responsibilities

Prepare, audit, and generate complex payment files for submission to payment vendors in accordance with established schedules, client requirements, and regulatory guidelines
Validate payment file accuracy through detailed review of payment data, provider information, offsets, adjustments, and reconciliation balancing
Submit payment files through designated vendor platforms and ensure successful transmission, receipt, and processing
Monitor payment submissions for rejections, exceptions, or error notifications and take immediate corrective action to prevent payment delays
Perform detailed reconciliations between vendor platforms, internal systems, bank reporting, and payment batches to ensure financial accuracy and completeness
Research, analyze, troubleshoot, and resolve payment file discrepancies, balancing issues, and processing errors in a timely manner
Serve as a subject matter resource and liaison for provider payment release requests, escalated inquiries, and payment status investigations
Process payment reissue, void, stop payment, recoupment, and offset requests in accordance with department procedures and compliance standards
Create and validate client refund files for Accounting department processing and reconciliation
Collaborate cross functionally with internal departments, external vendors, banking partners, and IT resources to resolve discrepancies, transmission failures, and file format issues
Maintain detailed documentation and audit ready records of payment submissions, corrections, reconciliations, approvals, and outcomes
Analyze payment activity trends and provide reporting related to payment accuracy, aging, rejection trends, reconciliation findings, and resolution timelines
Identify operational risks, process inefficiencies, and recurring payment issues and recommend process improvements to enhance accuracy, reduce rework, and improve turnaround times
Support revenue cycle operations through accurate and timely disbursement processing while ensuring adherence to client contractual obligations and departmental service levels
Generate, analyze, and reconcile reports from Data Warehouse and applicable systems to identify Provider Accounts Payable due and outstanding payment activity
Reconcile Jopari payment acknowledgement reports against payment batch files to identify invoices requiring voids, corrections, or internal reprocessing
Generate Explanation of Reimbursement (EOR) documentation and coordinate distribution processes
Manage and prioritize the AP queue for provider payment requests, escalations, research items, and inquiries while maintaining service expectations
Generate and review outstanding AP reports with Manager, Revenue Management and assist in identifying trends, risks, and resolution strategies
Assist with departmental audits, special projects, workflow enhancements, system testing, and implementation initiatives as assigned
Provide support and training to team members regarding payment processing workflows, reconciliation procedures, and issue resolution processes
Maintain confidentiality and safeguard sensitive financial, provider, and client information in compliance with company policies and regulatory standards
Maintain reliable and predictable attendance during scheduled work hours.
Demonstrates a customer-first mindset by developing a broad and deep (where appropriate) understanding of Paradigm organization, products, operations, and customers. Prioritizes collaboration to meet customer needs and expectations and takes personal accountability for service quality.
Utilizes AI tools to support day-to-day tasks, improve efficiency, and enhance output quality. Adopts new technologies as trained and applies them in alignment with established processes and guidelines.
Responsible for complying with Paradigm Information Security requirements and policies, for safeguarding Paradigm or Paradigm related passwords, and for notifying Paradigm of any Information Security incidents per policy SEC 10-12 Information Security Incident Management.