Payment Application Specialist

Responsible for the timely and accurate posting of payments and adjustments into the hospital proprietary billing system.  They will be responsible for processing of 835 ERA, ACH, EFT transactions, processing USPS Mail and Inter-office mail, balancing daily batches and assisting with daily reconciliation, initiating and monitoring of automated software posting programs, preparing documentation for reconciliation and auditing.  Embodies the Memorial Health System Performance Excellence Standards of Safety, Courtesy, Quality, and Efficiency that support our mission, vision and values.

Education:

• Education equivalent to graduation from high school or GED is required. Associates preferred.

Experience:

• Two (2) years of experience in billing, insurance, collections, or related background required. Previous experience with the processing of Insurance and Contractual Allowance aspects of Commercial and Managed Care contracts is highly preferred.

Other Knowledge/Skills/Abilities:

• Ability to read and interpret ERAs (Electronic Remittance Advice), ACHs (Automated Clearing House) transactions, EFTs (Electronic Fund Transfers), and EOBs (Explanation of Benefits)/EOPs (Explanation of Payment).
• Demonstrates the ability to accurately type net 30 WPM (alphanumeric).
• Demonstrates the ability to accurately key net 6000 KPH (numeric).
• Basic working knowledge of personal computers and their associate user software is required. Experience with Microsoft Office products Word and Excel is preferred.
• Demonstrated ability to work successfully with internal customers and external contacts is required.
• Demonstrates excellent oral and written communication, keyboarding, and basic math skills.

• Accesses Web Based Portals and Downloads ERA, ACH and report files from payors.
• Prepares files for processing, initiates and monitors Posting Software Applications ensuring careful adherence to guidelines, timeliness, accuracy, and processing procedures. At prescribed intervals, follows up for review to ensure smooth processing and timely delivery of outstanding payments.
• Investigates assigned payments with incomplete or questionable information and resolves problems or errors to ensure complete information accompanies the payment.
• Calculates contractual adjustments and applies to patients’ online accounts, notating the electronic file accordingly.
• Embodies the Memorial Health System Performance Excellence Standards of Safety, Courtesy, Quality, and Efficiency that support our mission, vision and values: 
• Receives, sorts, and stamps incoming United States Post Office and Inter-department mail. Identifies and Batches 3rd Party and Patient payments for processing. Bundles and/or delivers mail correspondence team for attention and handling.
• Processes and analyzes explanation of benefit (EOB) forms to determine reasons for denial, exclusion, or under payment.
• Follows up on outstanding or unapplied payments and other issues associated with payments.
• Researches and resolves complex issues associated with payments on patient accounts. As applicable, identifies, documents, and reports problematic trends to management.
• Analyzes reports containing rejected payment information and performs the necessary research to resolve the reason(s) for the rejection and secures any other required information.
• Prepares daily bank deposit and arranges for daily delivery or pick to/from the Security Department. Ensures the security of deposit at all times.
• Provides input regarding system edits designed to identify and ensure consistent and compliant data necessary for processing patient payments.
• Communicates and resolves issues with a variety of internal sources to resolves issues involving patient payments.
• Initiates corrections to charges and contractuals / allowances within scope of expertise and authority granted.
• Adhere to HIPAA Privacy Regulations and maintain patient confidentiality
• Identifies and calculates write-off amounts and secures the necessary approvals from management for processing.
• Documents online systems and electronic files to ensure accurate data is noted regarding the status of payments.
• Performs a variety of filing and/or retrieval of electronic and paper forms and files. Maintains files according to prescribed procedures and may arrange for long-term storage of EOBs or other items.
• As directed and defined by management, orients and cross-trains on other unit duties which are outside of regularly assigned area of responsibility. May serve as a back up for other areas within the unit or department, especially during times of special needs or staff absences.
• Performs other related work as required or requested.

The intent of this job description is to provide a representative summary of the major duties and responsibilities performed by incumbents of this job.  Incumbents may be requested to perform tasks other than those specifically presented in this description.