Revenue Cycle Specialist - Payments & Remittance

The Revenue Cycle Specialist, Payments & Remittance is responsible for accurately posting and reconciling insurance payments into the practice management system while ensuring compliance with contractual and regulatory guidelines. This role requires strong attention to detail, the ability to work across multiple systems, and a commitment to meeting accuracy and productivity benchmarks.

This is a 100% remote position.

Responsibilities

• Accurately post insurance payments, adjustments, and denials to client accounts in an accurate and timely manner.
• Review and reconcile check deposits, EFTs, and lockbox reports to ensure completeness and accuracy of payment posting.
• Ensure all payments are posted in accordance with payer contracts and client-specific rules.
• Maintain a high level of productivity while meeting quality standards, including 99%+ accuracy.
• Ensure all payments are matched and reconciled on the Reconciliation Report, documenting reasons for any discrepancies.
• Manage the Zentist portal daily to mark payments as posted and ensure the daily deposit is complete.
• Assign denied claims to denial management and AR teams within Denticon’s task manager to ensure proper handling of underpayments.
• Monitor and process Electronic Remittance Advice (ERA) in DentalxChange.
• Resolve payments with missing Explanation of Benefits (EOB).
• Acquire ERA/EOB files from multiple sources, including DentalxChange, Zentist, payor portals, and phone calls to payors.
• Escalate recurring payer issues or payment variances to the Revenue Cycle Manager for resolution.
• Maintain status reporting of workload on the Daily Tracker for payment and denial posting, reconciliation, and ERA processing.
• Pre-audit and escalate fee discrepancies to the fees team.
• Initiate refund tickets for received overpayment requests from payors.
• Adhere to HIPAA guidelines and internal compliance protocols.

Performance Metrics

• Post 30+ payments or adjustments per hour worked, including auto-posted payments.
• Maintain a minimum 99% accuracy rate for all posting activities.
• Complete manual payment postings within 2 business days of receipt.
• Complete ERA auto-posting reconciliation within 5 business days of posting.