Payment Posting Specialist

Position Title: Healthcare Payment Posting Specialist

Department: Business Office

Supervisor's Title: Business Office Manager

IHA #: 302270

Position Summary

The Healthcare Payment Posting Specialist is responsible for the accurate and timely posting of patient and insurance payments, reconciliation of payment batches, monitoring payment variances, and assisting with revenue cycle activities that support cash collections and account resolution. This position ensures payments, adjustments, and denials are processed accurately while maintaining balanced daily posting records and supporting compliance with payer and organizational requirements.

Principal Functions and Responsibilities

1. Payment Posting & Reconciliation

• Retrieve and process electronic and manual remittance advice from payers and clearinghouses.
• Prepare, organize, and reconcile insurance payment batches to ensure accurate posting and balancing.
• Post patient and insurance payments accurately and timely to appropriate accounts.
• Verify patient identifiers, dates of service, and account information prior to posting payments.
• Apply appropriate contractual adjustments, deductibles, copayments, coinsurance amounts, and other payer-specific adjustments.
• Export and process electronic remittance files within revenue cycle systems.
• Reconcile posted payment batches daily and resolve discrepancies to ensure accurate balancing.
• Run and review daily posting reports and reconciliations to verify posting accuracy.
• Research unidentified payments, recoupments, and posting discrepancies to determine appropriate account resolution.

2. Insurance Payment Analysis & Account Resolution

• Review Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERA) documents and accurately interpret payer adjudication.
• Identify denials, underpayments, payment variances, and reimbursement issues and route accounts for appropriate follow-up.
• Monitor insurance payment trends and reimbursement activity that may impact cash flow.
• Communicate significant reimbursement concerns, payer issues, or payment delays to leadership in a timely manner.
• Assist with insurance follow-up activities, including denial resolution and account research as assigned.

3. Credit Balance & Refund Management

• Monitor and process all credit balances on a daily basis, ensuring credits are applied, transferred, refunded, or otherwise resolved in accordance with Valor Health policy and established timelines.
• Research and resolve patient and insurance credit balances by identifying the appropriate disposition, including payment transfers, account adjustments, refunds, or other corrective actions.
• Process patient and insurance refunds accurately and timely, ensuring appropriate approvals, documentation, and compliance with organizational policies and regulatory requirements.
• Investigate and resolve payer recoupments, overpayments, and other credit balance discrepancies to ensure accurate account resolution.
• Maintain complete and accurate documentation supporting all credit balance, refund, transfer, adjustment, and recoupment activities.

4. Revenue Cycle Support

• Assist with implementation and optimization of electronic payment posting processes.
• Support billing work queues and other revenue cycle workflows as assigned.
• Assist patients with billing and payment-related inquiries when appropriate.
• Collaborate with Revenue Cycle, Finance, and other departments to improve payment posting accuracy and efficiency.
• Assist with preparation of Medicare and Medicaid bad debt documentation and related annual cost report support activities.

5. Compliance & Documentation

• Maintain accurate documentation of payment posting, reconciliation, refund, and adjustment activities.
• Adhere to Valor Health policies, revenue cycle procedures, and applicable federal and state regulations.
• Ensure compliance with HIPAA and all patient confidentiality requirements.
• Maintain current knowledge of payer rules, reimbursement methodologies, and payment posting best practices.

6. General Responsibilities

• Work closely with Finance leadership to ensure daily, weekly, monthly, and year-end reconciliation requirements are completed accurately.
• Participate in month-end closing activities and maintain availability during designated closing periods.
• Attend departmental meetings, training sessions, and quality improvement initiatives.
• Maintain effective working relationships with patients, staff, payers, and external partners.
• May be required to work overtime, weekends, or holidays based on operational needs.
• Perform other duties as assigned.