Payment Specialist II

UPMC Revenue Cycle is hiring a Payment Specialist II to join our team. The Payment Specialist II will work Monday through Friday during business hours at our Revenue Cycle office at UPMC Western Maryland in Cumberland, MD with the potential to work from home.

In this role, you will analyze, post, balance, and report payments and denials for designated entities and payers to the appropriate billing system(s).  As the Payment Specialist II you will manage electronic remittance file retrieval and posting as well as other various control processes (imaging, spreadsheet updating, account monitoring, etc).

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Responsibilities:

• Expanded knowledge of PLB processes by the payer. Includes the aptitude to recognize when a PLB should be posted to a patient's account and verify with the billing department.Attention to detail when reviewing the EOB correspondence batches in the banking system with the ability to identify issues and present to management.
• Interpret and key RAC Audit correspondence into the Audit system. Understand payment posting and the relationship between co-pays, deductibles, co-insurance, allowances, and payments so that the account balance is accurate after payment is posted. Ability to navigate various payer websites or call payer directly when needed.
• Key payment data from lockbox work capturing all relevant data including payer remark codes that would assist the Billing Department to determine how to follow up on a denial. Verify that funds are in the bank prior to posting. Import and post files, and reconcile funds in the bank to payments posted. Print posted reports and manually post to the patient billing system any rejected payments and close the receivable to the next responsible payer as warranted.
• Post and reconcile non-sufficient funds, credit files, stop payments and any/all miscellaneous bank account debit adjustments and chargebacks. Verify, import, and post electronic remittance/denial files for assigned payers, ensuring that funds are in the bank prior to posting. Identify and communicate to management any unusual delays, balancing issues, new codes or adjustments.
• Manually resolve any rejected payments (post, refund or transfer) for electronic remittance files. Print summary reports. Generate and distribute payer-specific electronic posting summary and exception reports to department designee immediately upon completion of payer file run.
• Thoroughly research questionable/unidentified payments to post properly. Contact insurance carriers, complete documentation forms and follow up on any amounts posted to suspense, UTL, or clearing accounts. Items posted to suspense, UTL, or clearing accounts must be resolved within 7 days, or notice must be provided to the supervisor of the reason for the extended delay.
• Recognize bad debt transactions and supply proper documentation to ensure bad debt payment is posted accurately into any and all patient billing systems or legacy master spreadsheets.
• Post and/or code non-cash data accurately by selecting the standard code to designate the reason (payment denial, admission approval, refund request, etc). Post memo or contractual adjustment if warranted, and close the receivable to the next payer if warranted. Prepare documentation for payments that must be transferred to another UPMC entity, or refunded to payer. Ensure accurate posting of payments that belong to another UPMC entity or prepare appropriate documentation so that funds can be transferred or refunded.
• Consistently meet departmental productivity standards as set by management. Apply undistributed payments on any and all patient billing following established guidelines.
• Serve as a resource to other employees, as requested by management. Performs HB, PB & SBO payment postings.