Paradigm Oral Health
Remote RCM Payment Posting Specialist
Paradigm Oral Health, Lincoln, Nebraska, United States, 68506
Job Description
Job Description
ROLE OVERVIEW The Payment Posting Specialist is responsible for posting and reconciling insurance payments, ensuring accuracy in patient accounts, and identifying discrepancies.
KEY RESPONSIBILITIES Post and reconcile insurance payments (EFTs, checks, paper EOBs) into the system daily. Ensure proper payment allocation, identifying and correcting misapplied payments. Identify and process underpayments, overpayments, and necessary refunds. Review credit balances to determine if refunds are due to patients or insurance carriers. Initiate and process refund requests in accordance with company policies and payer guidelines. Collaborate with the AR, Billing, and Collections teams to resolve payment discrepancies and avoid unnecessary refunds. Work closely with accounting/finance teams to ensure timely refund disbursements. Monitor payer trends in payments, denials, and adjustments, escalating issues as needed. Maintain compliance with payer guidelines, HIPAA, and internal SOPs. Assist with ad-hoc projects and audits as assigned by leadership.
ESSENTIAL QUALIFICATIONS
Prior experience in dental office revenue cycle functions, with expertise in: Scheduling & Registration – Understanding patient flow and eligibility verification. Insurance Verification – Confirming coverage, benefits, and policy limitations. Fee Schedules & Charging/Coding – Ensuring accurate claim submission using CDT, CPT, and ICD-10 codes. Claim Submission & Follow-Up – Knowledge of clean claim processing, payer-specific requirements, and handling
rejections/denials. Insurance AR & Payment Posting – Reconciling EOBs, applying payments correctly, and identifying underpayments. Strong knowledge of reimbursement & compliance processes for: Medicare, Medicaid, PPO, HMO, and Fee-for-Service (FFS) plans Payer guidelines, coordination of benefits (COB), and timely filing limits Insurance dispute resolution and appeal submission best practices Proficiency in dental billing software & industry tools: Practice Management Systems (PMS): CareStack, WinOMS, OMSVision, Dentrix, Eaglesoft, etc. Insurance Portals & Clearinghouses: Working with Navinet, Availity, Change Healthcare, and payer-specific platforms Banking Reconciliation Software: Matching deposits to payments for financial accuracy Microsoft Office Suite: Strong Excel skills for data analysis and reporting Technical & Analytical Skills Strong computer literacy with intermediate to advanced Excel proficiency (pivot tables, v-lookups, reporting). Excellent math and problem-solving skills related to claim calculations and insurance adjustments. Data entry expertise, including 10-key by touch, ensuring speed and accuracy in financial transactions. Soft Skills & Work Ethic Strong interpersonal and organizational skills to work effectively within a team and independently. Excellent oral and written communication skills, particularly in handling payer escalations and patient billing inquiries. Demonstrates attention to detail, accuracy, and analytical thinking in identifying claim discrepancies. Accountable for quality work, meeting deadlines, and adhering to RCM compliance and SOPs.
What We Offer: Core Benefits & Wellness Comprehensive Medical, Dental & Vision Insurance (Virtual Care included) Confidential Employee Assistance Program (EAP) for you and your family
Financial Wellness Competitive Pay with Bonus Opportunities & Annual Merit Increases 401(k) Retirement Plan with Company Match Health Savings Account (HSA) options with HDHP plans
Life Insurance Protection Company-Paid Basic Life Insurance Optional Supplemental Life Coverage for You, Your Spouse & Children
Time Away & Life Balance Generous Paid Vacation (starting at 2 weeks!) + 6 Paid Holidays Short- and Long-Term Disability Coverage Supportive Leave of Absence Options
Job Description
ROLE OVERVIEW The Payment Posting Specialist is responsible for posting and reconciling insurance payments, ensuring accuracy in patient accounts, and identifying discrepancies.
KEY RESPONSIBILITIES Post and reconcile insurance payments (EFTs, checks, paper EOBs) into the system daily. Ensure proper payment allocation, identifying and correcting misapplied payments. Identify and process underpayments, overpayments, and necessary refunds. Review credit balances to determine if refunds are due to patients or insurance carriers. Initiate and process refund requests in accordance with company policies and payer guidelines. Collaborate with the AR, Billing, and Collections teams to resolve payment discrepancies and avoid unnecessary refunds. Work closely with accounting/finance teams to ensure timely refund disbursements. Monitor payer trends in payments, denials, and adjustments, escalating issues as needed. Maintain compliance with payer guidelines, HIPAA, and internal SOPs. Assist with ad-hoc projects and audits as assigned by leadership.
ESSENTIAL QUALIFICATIONS
Prior experience in dental office revenue cycle functions, with expertise in: Scheduling & Registration – Understanding patient flow and eligibility verification. Insurance Verification – Confirming coverage, benefits, and policy limitations. Fee Schedules & Charging/Coding – Ensuring accurate claim submission using CDT, CPT, and ICD-10 codes. Claim Submission & Follow-Up – Knowledge of clean claim processing, payer-specific requirements, and handling
rejections/denials. Insurance AR & Payment Posting – Reconciling EOBs, applying payments correctly, and identifying underpayments. Strong knowledge of reimbursement & compliance processes for: Medicare, Medicaid, PPO, HMO, and Fee-for-Service (FFS) plans Payer guidelines, coordination of benefits (COB), and timely filing limits Insurance dispute resolution and appeal submission best practices Proficiency in dental billing software & industry tools: Practice Management Systems (PMS): CareStack, WinOMS, OMSVision, Dentrix, Eaglesoft, etc. Insurance Portals & Clearinghouses: Working with Navinet, Availity, Change Healthcare, and payer-specific platforms Banking Reconciliation Software: Matching deposits to payments for financial accuracy Microsoft Office Suite: Strong Excel skills for data analysis and reporting Technical & Analytical Skills Strong computer literacy with intermediate to advanced Excel proficiency (pivot tables, v-lookups, reporting). Excellent math and problem-solving skills related to claim calculations and insurance adjustments. Data entry expertise, including 10-key by touch, ensuring speed and accuracy in financial transactions. Soft Skills & Work Ethic Strong interpersonal and organizational skills to work effectively within a team and independently. Excellent oral and written communication skills, particularly in handling payer escalations and patient billing inquiries. Demonstrates attention to detail, accuracy, and analytical thinking in identifying claim discrepancies. Accountable for quality work, meeting deadlines, and adhering to RCM compliance and SOPs.
What We Offer: Core Benefits & Wellness Comprehensive Medical, Dental & Vision Insurance (Virtual Care included) Confidential Employee Assistance Program (EAP) for you and your family
Financial Wellness Competitive Pay with Bonus Opportunities & Annual Merit Increases 401(k) Retirement Plan with Company Match Health Savings Account (HSA) options with HDHP plans
Life Insurance Protection Company-Paid Basic Life Insurance Optional Supplemental Life Coverage for You, Your Spouse & Children
Time Away & Life Balance Generous Paid Vacation (starting at 2 weeks!) + 6 Paid Holidays Short- and Long-Term Disability Coverage Supportive Leave of Absence Options