PFS Payment Posting Specialist - Revenue Cycle (1.0 FTE, Days)
1.0 FTE, 8 Hour Day Shift
At Stanford Children’s Health, we know world-renowned care begins with world-class caring. That's why we combine advanced technologies and breakthrough discoveries with family-centered care. It's why we provide our caregivers with continuing education and state-of-the-art facilities, like the newly remodeled Lucile Packard Children's Hospital Stanford. And it's why we need caring, committed people on our team - like you. Join us on our mission to heal humanity, one child and family at a time.
This paragraph summarizes the general nature, level and purpose of the job.
A Payment Posting Specialist reconciles bank deposits, posts payments and adjustments based on contracted rates and patient’s individual Health Plans and also finds resolution to credit balances.
The essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks, and responsibilities. Employees may also perform other duties as assigned.
Employees must abide by all Joint Commission Requirements including but not limited to sensitivity to cultural diversity, patient care, patient rights and ethical treatment, safety and security of physical environments, emergency management, teamwork, respect for others, participation in ongoing education and training, communication and adherence to safety and quality programs, sustaining compliance with National Patient Safety Goals, and licensure and health screenings.
Must perform all duties and responsibilities in accordance with the hospital’s policies and procedures, including its Service Standards and its Code of Conduct.
- Reconciles deposits received in the Bank: Validate that all Insurance and Patient payments deposited into the bank account were imported into Epic’s Cash Management Module to be posted. This includes both ACH and Lockbox deposits.
- Reviews electronic remittance advices (ERAs) including validating that electronic posting files are received and loaded in Epic for proper posting.
- Requests and makes any pertinent corrections to the ERAs.
- Searches and retrieves Explanation of Benefits documents from Clearing Houses portals as well as from payer’s websites.
- Adjusts system reported Non Accounts Receivables, such as Interests, Capitation, etc.
- Receives and completes requests from other teams regarding missing payments and inaccurate posting.
- Resolves Credit Balances via Distribution or Transfer of payments as well as Refund Processes.
- Collaborates with the Finance Department to complete month-end reports and reconciliation process.
- Reports payment discrepancies to Manager and Director.
- Tracks and researches unapplied cash, complete root cause analysis and escalate to Management as needed.
- Establishes and maintains effective working relationships and communicate clearly with other departments, patients, vendors and insurance companies.
- Maintain confidentiality of all patient information and all applicable HIPPA rules.
- Performs additional duties as assigned.
Any combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying.
- Education: High School diploma or GED equivalent
- Experience: Two (2) years of progressively responsible and directly related work experience in a healthcare setting
- License/Certification: None required.
Knowledge, Skills, & Abilities
These are the observable and measurable attributes and skills required to perform successfully the essential functions of the job and are generally demonstrated through qualifying experience, education, or licensure/certification.
- Ability to work independently but also follow oral and written instructions and interpret institutional and other policies accurately.
- Knowledge of major medical insurance practices and carriers.
- Ability to gather, analyze, and display data in appropriate formal and keep accurate records.
- Ability to maintain confidentiality of sensitive information.
- Ability to perform basic mathematics.
- Ability to use critical thinking to problem solve on a regular basis.
- Ability to plan, prioritize and meet deadlines with little supervision.
- Ability to manage time efficiently.
- Ability to meet position’s goals and objectives related to accuracy and productivity e.g. posting accuracy, AR/EOB reconciliations, etc.
- Ability to be highly attentive to details and organization.
- Ability to work effectively with individuals at all levels of the organization.
- Knowledge of insurance and medical terminology.
- Knowledge of billing/payment software systems like Epic, Payment Manager, Waystar.
- Knowledge of computer systems and software used in functional area.
- Knowledge of Managed Care products such as HMO, PPO, POS, etc.
- Knowledge of principles and practices of customer service and telephone
The Physical Requirements and Working Conditions in which the job is typically performed are available from the Occupational Health Department. Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions of the job
Equal Opportunity Employer