$24 – $33 Hourly
Position Summary:
As a Reimbursement Specialist II, Payment Posting, you are a seasoned expert within the revenue cycle team, driving impact through deep knowledge of insurance processes, payer policy, and driving payment for our services. You play a key role in partnering with colleagues in Finance and Client Services while maximizing reimbursement outcomes for the organization. You will facilitate optimized billing processes and operations that are aligned with Guardant Health’s mission and values.
You will independently manage posting cash receipts and EOBs in the billing tool and ensure that daily cash from the lockbox is reconciled to patient accounts efficiently and accurately. With your extensive background in healthcare billing and payer engagement, strong attention to detail is critical. Strong communication and troubleshooting skills are required to manage unbalanced remittance advice directly with payers.
You’ll help build and maintain comprehensive documentation of payer requirements and support process improvement initiatives that increase efficiency and effectiveness across the department.
Key Responsibilities:
- Revenue Cycle Management:
- Quickly analyze and interpret details from EOB/ERA files to ensure accurate posting of payments and adjustments against appropriate line-item service in a timely manner. (Not limited to identifying errors)
- Posting all denied charges for appeals department
- In-depth knowledge of healthcare remark/ reason codes, advice codes, and definitions
- Familiarity with credits, debits, adjustments, takebacks, patient responsibility, allowed amounts, deductibles, co-pays, and coinsurance
- Understanding of denied charges, denial reasons, and claims adjudication processes
- Allocating Patient Payments to the appropriate account in a timely manner
- Manage credit card transactions including credits, refunds, and chargebacks
- Reconciling all bank transactions while meeting monthly deadlines (Not limited to identifying missing payments)
- Daily, monthly, quarterly, and annually reconcile credits and debit transactions received by the financial institution.
- Assist with annual audits, SOX compliance, month-end closures, and identify and communicate variances.
- Capacity to handle and process high-value data efficiently and accurately
- Proficiency in navigating clearinghouses and working with various insurance health plans
- Utilizing third-party payer portals for claims and payment verification
- Conducting thorough research independently to resolve payment discrepancies and issues
- Efficiently escalating complex payment issues as needed to ensure timely resolution
- Manage incoming correspondence from various channels (fax, email, portal) and associate them with the relevant patient/insurance records.
- Communicating effectively via email, fax, and other channels with payers and internal stakeholders
- Excellent oral and written communication skills for effective collaboration and reporting
- Handling outbound and inbound calls to follow up on payment statuses and resolve issues
- Respond to emails efficiently and effectively within the department.
- Experience in identifying and reporting trends by Payer
- Strong attention to detail and accuracy in data input and recordkeeping
- Proficiency in utilizing spreadsheets for data analysis and reporting
- Aid in enhancing automation of electronic enrollments with payers such as EDI, EFT, ERA and payer portal registrations
- Performs other added responsibilities as assigned to support the overall efficiency of the department.
- Participate in ongoing training and education programs for software and systems used in the role.
- Aid in enhancing automation of electronic enrollments with payers such as EDI, EFT, ERA and payer portal registrations
- Demonstrating strong time management skills to meet deadlines and ensure payment processing efficiency
- Maintaining a high level of accuracy and attention to detail in all reimbursement and cash application tasks
- All job duties must be performed in a manner that demonstrates the company Leadership Attributes and support of the Mission & Values of the company.
- Maintain the strictest confidentiality; adhere to all HIPAA guidelines/regulations.
- Cross-functional Collaboration:
- Communicate effectively with cross-functional teams to identify and address inefficiencies impacting ASP and claims adjudication processes.
- Work closely with staff to investigate and resolve credit balances, missing payments, payment allocations or discrepancies related to claims/appeals.
Travel Requirements:
This role may require some travel that may include, but is not limited to:
- Participating in corporate events and quarterly/biannually/annually meetings to connect and share innovative strategies.
- Engaging in development opportunities and conferences that will enhance your skills and knowledge, empowering you to lead initiates effectively.
- Initiating and participating in teambuilding activities in person and collaborating with cross-functional teams to foster a strong, united workplace culture.
Qualifications
- Minimum of 3-5 years recent experience in both professional and facility health care claims posting, including knowledge of health plan regulations and processes with high volume and/or multiple accounts.
- Experience with contacting and follow up with insurance carriers; national as well as regional payers throughout the country.
- Must have strong mathematical skills evidenced by a prior history of month end and quarter end close in prior roles.
- Experience with managing incoming transactions from multiple lockboxes, ACH credit/debits, wire transfers, manage credit card processing with multiple gateways and merchant accounts as well as check scanners.
- Proficiency with revenue cycle tools, experience with laboratory reimbursement workflows, EDI enrollment, Payer Portal setup & management, Telcor, Waystar Clearinghouse, and Sarbanes Oxley controls (SOX) are requirements is highly desirable.
- Proven track record of working cross-functionally with internal teams and external stakeholders to resolve reimbursement challenges.
- Exceptional attention to detail, self-motivated, organizational abilities and driven to identify process improvements that enhance operational performance.
- Demonstrated proficiency with using computer hardware and PC software, specifically Microsoft Office Suite, Adobe Acrobat PDF, particularly Excel, and have above average typing skills
- Analytical mindset with experience in data analysis and process optimization.
- Ability to work independently and handle confidential and sensitive information with utmost discretion.
- Must be able to work cohesively in a team-oriented environment and be able to foster good working relationships with others both within and outside the organization
- Excellent communication and interpersonal skills to facilitate collaboration across department, with an ability to distill complex issues for both technical and non-technical audiences.
