Columbia Orthopaedic Group

Job Title: Payment Integrity Specialist

Location: Columbia Orthopaedic Group

Job Summary:The Payment Posting and Refund Specialist is responsible for managing and processing both payments received from insurance companies and patients, as well as overseeing refund requests. This role combines the duties of posting payments, addressing payment discrepancies, and processing patient and insurance refunds. The position involves ensuring the accuracy and timeliness of payment posting and refund processing, collaborating with the billing department, insurance companies, and patients, and maintaining compliance with all relevant regulations. The ideal candidate will be highly organized, detail-oriented, and able to manage multiple tasks efficiently within an orthopedic practice setting.

Key Responsibilities:

Payment Posting:

• Accurately post payments and adjustments to patient accounts and financial records using appropriate billing software.
• Review and verify payment information to ensure accuracy and completeness.
• Maintain detailed records of all payment transactions.
• Monitor and address outstanding payment discrepancies, denials, and follow up for timely resolution.
• Work with healthcare providers, insurance carriers, and the billing department to resolve payment issues and ensure prompt processing.
• Ensure compliance with federal, state, and payer-specific regulations regarding payment posting.

Refund Processing:

• Review and process patient and insurance refund requests in accordance with company policies and procedures.
• Ensure accurate calculation and verification of refund amounts.
• Communicate with patients and insurance companies to resolve refund issues and obtain necessary approvals.
• Update and maintain detailed refund records in the practice management system.
• Investigate and resolve complex refund issues or disputes, escalating to management as needed.
• Ensure compliance with legal, regulatory, and internal policy requirements related to refunds.

Patient and Insurance Communication:

• Communicate with patients regarding payment inquiries, account balances, and refund-related questions.
• Respond to patient inquiries in a timely and professional manner, providing clear explanations.
• Collaborate with insurance companies to resolve payment discrepancies and obtain necessary approvals for refunds.
• Maintain clear, detailed documentation of all communications related to payments and refunds.

Collaboration and Support:

• Work closely with the billing department to reconcile accounts, resolve billing discrepancies, and ensure smooth payment processing.
• Assist in the development and improvement of procedures to enhance both payment posting and refund processing efficiency.
• Collaborate with the finance team to track and report on payment posting and refund metrics, identifying trends and areas for improvement.

Documentation and Compliance:

• Maintain thorough documentation of all payment posting and refund transactions.
• Ensure compliance with all legal, regulatory, and internal policy requirements.
• Perform audits of payment and refund transactions periodically to ensure accuracy and adherence to policies.

Problem-Solving:

• Investigate and resolve complex issues related to payment posting and refunds, recommending process improvements where necessary.
• Provide feedback to improve the efficiency and accuracy of the payment posting and refund processes.

Qualifications:

• Education: High school diploma or equivalent required; additional education in healthcare billing, finance, or accounting preferred.
• Experience: At least 2-3 years of experience in medical billing, payment posting, or financial processing in a healthcare setting.
• Skills:
  • Proficiency in medical billing software, practice management systems, and financial software.
  • Strong attention to detail, accuracy, and analytical skills.
  • Excellent communication and interpersonal skills.
  • Strong problem-solving abilities and the ability to prioritize tasks effectively.
  • Ability to handle sensitive financial information with confidentiality.

Working Conditions:

• Environment: Office setting within an orthopedic practice, with potential for hybrid work after six months of employment.
• Hours: Full-time position, typically Monday to Friday, with standard office hours.
• Physical Requirements: Ability to sit for extended periods and use a computer. Occasional overtime may be required.

Additional Information:The Payment Integrity Specialist will play a critical role in ensuring the practice's revenue cycle functions efficiently and accurately. The role requires collaboration with multiple departments, excellent organizational skills, and a high level of attention to detail. Strong communication skills are essential for interacting with patients, insurance companies, and internal stakeholders to resolve payment and refund-related issues.