Payment Specialist - TMG Billing (Days)

Tanner Health•Carrollton, GA

2d•Onsite

About The Position

The payment posting team applies insurance payments to line item services for all TMG physician clinics. Must understand insurance details, CARC (Claim Adjustment Reason Codes), insurance correspondence, and secondary claims. Position must be proficient in posting Medicare, Medicaid and Commercial insurance payments for rural and non-rural clinics. Must possess a thorough understanding of payment posting and the explanation of benefits key date. Must ensure payments, allowances, adjustments, write-offs and recoupments are posted correctly with a 95% rate of accuracy within 48 hour turnaround time via ERA and manual posting procedures. Must possess thorough understanding of daily balancing procedures and work closely with Accounting to resolve discrepancies within a timely fashion.

Requirements

High School Diploma or GED
Two years of related experience.
Requires working knowledge of specialized practices, equipment, and procedures.
Ability to organize, analyze and prioritize work load.
Ability to work closely with others and function as a team number.
Detail oriented.
Knowledge of word processing and spreadsheets required. MS Word and MS Excel preferred.
Must be proficient with a calculator.
Must have two years experience in medical insurance billing and medical office business office functions.
Strong verbal communication skills.
Working knowledge of CPT & ICD Coding desired.

Nice To Haves

Data entry experience preferred.
Working knowledge of CPT & ICD Coding desired.

Responsibilities

Analyzes and posts correspondence (non-payment) within the Practice Management system in addition to ensuring the appropriate denial code (CARC RARC PRC) is assigned.
Payment specialist posts all insurance payments to appropriate line item within the Practice Management System. Position must be proficient in posting Medicare payments for both rural and non rural clinics as well as unique insurance contracts. Must possess a thorough understanding of payment posting and the explanation of benefits key data.
Post all monies within 48 hours of receipt at Central Business Office in addition to posting all checks the end of each month.
Post all non-payment (zero pay) information within Practice Management System, and ensure that appropriate CARC is applied.
Responsible for logging monies posted daily to EFT, Lockbox, and Accounting Log via SharePoint indicating posting date, batch number and ensure all batches are balanced.
Assign appropriate follow-up date to denials and refunds to ensure proper follow-up is performed by Insurance AR team.
Assists with special projects and account analysis procedures when asked.
Calculates and confirms the PPO and/or other contractual adjustment.
Develops and maintains a working knowledge of CPT and ICD coding.
Files and mails all secondary claims at the time of posting the primary insurance payment to include copying EOB.
Identifies payments belonging to other practices and processes accordingly.
In the event that monies are posted to TMG Refund Account, communicate to appropriate staff of needed research and resolve within 5 days of posting. In the event that money must remain on account longer than 5 days, Payment Specialist must receive approval from Accounts Manager or Director.
Maintains a current knowledge of the TMG Billing and Collections Procedures and the Practice Management Systems.
Maintains a good working relationship with other teams and physician practices for the purpose of resolving billing problems.
Maintains a high level of expertise in the unique requirements of individual payer and Health West PHO managed plans.
Maintains strict confidentiality.
Monitors work flow for the purpose of identifying and recommending solutions to problems that result in delays.
Participates in educational activities and attends monthly staff meetings.
Post all refund and recoupment request correspondence and distribute to appropriate insurance AR staff daily.
Prepares Accounting Logs by entering all TMG billing office receipts, adjustments, charges and voids for all clinics. Scans receipts and emails clinics. Provides support to the clinic staff when they have accounting logs issues. Balances all closed clinic's accounting logs and forwards to accounting department.
Prepares deposit ticket and processes checks for deposit.
Processes the mail daily to include opening the checks and batching accordingly.
Provides customer service functions to include addressing patient inquiries and complaints from all sources in a timely manner. Initiates necessary corrections to patients accounts and attempts to repair any damage done to relationship with patient. This will require interaction with co-workers, physicians offices and insurance carriers. Success indicated when problems are resolved by team members requiring little director intervention.
Provides high quality services to all customers, which includes, but is not limited to patients, physicians, physician practice employees, coworkers and insurance companies.
Remains alert for process improvements and recommends changes when change would be beneficial.
Researches checks to determine appropriate accounts for posting. Calls insurance company to confirm patient identity when necessary.
Review and correct PAYERR report biweekly. This report will be provided to Payment Specialist by Team Lead biweekly. Once correction is made, change follow-up reason code to PARCORR.
When necessary, research checks and or call insurance companies to confirm patient identity.
Works closely with Accounting to resolve balancing discrepancies within 48 hours.