1. Advanced Payment Posting
- Process and post insurance and patient payments accurately from EOBs, ERAs, EFTs, checks, and other payment sources.
- Handle complex payment scenarios, including multiple claims, split payments, recoupments, takebacks, refunds, and credit balances.
- Ensure payments, contractual adjustments, patient responsibility, and balance transfers are accurately posted.
- Follow client-specific payment posting guidelines and contractual rules.
2. EOB / ERA Analysis
- Perform detailed review of EOBs and ERAs.
- Analyze payment variances and identify incorrect or missing contractual adjustments.
- Identify underpayments, overpayments, zero-pay claims, incorrect patient responsibility, and payer discrepancies.
- Validate that the claim-level and service-line-level amounts reconcile with the remittance.
3. Denial & Exception Identification
- Identify complex denial and rejection patterns during payment posting.
- Categorize denials and route them to the appropriate AR/Denials team.
- Identify recurring payer issues and escalate trends to the Team Lead/Manager.
- Review unusual transactions and determine the appropriate next action based on SOP.
4. Payment Reconciliation
- Perform daily and batch-level reconciliation of payments.
- Reconcile EOB/ERA → payment batch → system posting → account balance.
- Identify missing, duplicate, incorrect, or unidentified payments.
- Investigate discrepancies and coordinate with the appropriate internal/client team for resolution.
5. Credit Balance & Refund Review
- Identify credit balances and potential overpayments.
- Review refund-related transactions according to client guidelines.
- Escalate accounts requiring refund or recoupment processing.
- Ensure credit balances are properly documented and tracked.
6. Unapplied / Unidentified Payments
- Research and resolve unapplied or unidentified payments.
- Use available remittance, patient, claim, payer, and account information to identify the correct account.
- Maintain an appropriate tracker for unresolved payments and follow up within the required TAT.
7. Quality Control
- Perform self-audits and peer reviews when assigned.
- Review junior team members' transactions for accuracy.
- Identify recurring errors and provide corrective feedback.
- Support the team in maintaining required quality and accuracy benchmarks.
8. Team Support & Mentoring
- Guide Junior Payment Posters on complex transactions and EOB/ERA interpretation.
- Conduct knowledge-sharing sessions and process refreshers.
- Support new-hire training and nesting activities.
- Act as the first point of escalation for process-related questions.
9. Client & Process Compliance
- Follow client-specific SOPs, payer guidelines, and workflow requirements.
- Maintain compliance with HIPAA, data security, and organizational policies.
- Communicate process issues and recurring challenges to the Team Lead/Manager.
- Participate in process improvement initiatives.
10. Productivity & Performance
- Consistently meet or exceed assigned productivity and quality targets.
- Manage daily workloads according to TAT and priority requirements.
- Support the team during month-end and high-volume periods.
- Minimize rework, posting errors, and unresolved exceptions.
