Job Description

Job Summary: 

The Payment Posting Collections Specialist is responsible for accurately posting payments from third-party payers, maintaining accurate financial records, and managing accounts receivable collections. This role ensures compliance with all applicable regulations and supports the financial operations of the pharmacy. The ideal candidate will have strong attention to detail, excellent communication skills, and a background in healthcare or pharmacy billing and collections. 

Payment Posting: 

• Accurately and efficiently post electronic and manual payments received from third-party payers (e.g., Medicare, Medicaid, private insurance) into the pharmacy's billing system. 

• Reconcile payment postings with Explanation of Benefits (EOBs) and remittance advices to ensure accuracy. 

• Identify and resolve discrepancies between payments received and expected reimbursement. 

• Maintain accurate records of all payment postings. 

Collections: 

• Proactively monitor aging accounts receivable, identifying, and prioritizing delinquent claims. 

• Initiate collection efforts by contacting third-party payers to resolve outstanding balances. 

• Investigate and resolve claim denials and rejections, including resubmitting corrected claims and appealing denied claims. 

• Document all collection activities and communication with payers in the billing system. 

• Identify and escalate complex collection issues to Manager/Finance Manager. 

• Work with the payers to resolve any issues causing payment delays. 

Compliance: 

• Maintain compliance with all applicable federal and state regulations, including HIPAA and Medicare/Medicaid guidelines. 

• Adhere to the pharmacy's policies and procedures related to billing and collections. 

Other Duties: 

• Maintain a positive and professional relationship with internal and external participants. 

Qualifications:  

• Minimum of 2 years of experience in accounts receivable, preferably in a healthcare or pharmacy setting. 

• Strong understanding of third-party payer billing and reimbursement processes, including Medicare, Medicaid, and private insurance. 

• Proficiency in using pharmacy billing systems and electronic health records (EHR). 

• Excellent analytical skills. 

• Strong communication and interpersonal skills, with the ability to effectively interact with payers and internal staff. 

• Ability to work independently and as part of a team. 

• Strong organizational and time management skills, with the ability to prioritize and manage multiple tasks. 

Preferred Qualifications: 

• Experience in a long-term care pharmacy setting. 

• Certification in medical billing or coding. 

• Advanced proficiency in Microsoft Excel. 

Job Tags

Similar Jobs