Description:
Position Summary:
The Payments Specialist is responsible for accurately posting, reconciling, and managing insurance payments for behavioral health providers. This role ensures that all revenue received from insurance as a direct result of Compass' billing efforts is accurately recorded and tracked. The Payments Specialist plays a key role in supporting the financial health of both Compass and its clients by maintaining clean payment data, identifying underpayments or missed revenue opportunities, and collaborating with third-party vendors to optimize reimbursement outcomes.
Requirements:
Essential Duties and Responsibilities:
-
Accurately post and reconcile insurance payments and electronic remittances (ERAs)
-
Review and interpret Explanation of Benefits (EOBs) to ensure correct allocation of payments and adjustments.
-
Identify and escalate denied claims, underpayments, and payment discrepancies.
-
Coordinate with third-party vendors to mitigate cost-containment impacts and support repricing workflows.
-
Enter claim data into Compass’ workflow-management platform to support repricing and payment negotiation processes.
-
Monitor for opportunities to recover additional revenue through rate negotiations and appeals.
-
Maintain compliance with payer policies, HIPAA regulations, and internal documentation standards.
-
Deliver accurate and timely reporting to internal stakeholders to support decision-making and operational alignment.
-
Perform other duties as assigned by the Payments Supervisor or RCM Director.
-
Qualifications:
-
1–3 years of experience in medical billing, payment posting, or healthcare revenue cycle management (behavioral health preferred).
-
Familiarity with insurance reimbursement, claim processing, and third-party repricing vendors.
-
Strong attention to detail, organization, and data accuracy.
-
Proficiency with EHR systems, billing platforms, and Microsoft Office tools.
-
Effective written and verbal communication skills.
-
Strong critical thinking and problem-solving ability.
-
Key Metrics:
-
Payment Accuracy - Maintain accurate posting and reconciliation of payments with minimal errors or missed revenue.
-
Discrepancy Resolution - Identify and escalate underpayments, denials, and issues with third-party vendors in a timely manner.
-
Workflow Compliance - Enter claim and payment data into designated systems accurately and in accordance with department workflows.
-
Reporting & Collaboration - Provide timely, reliable updates and data to internal teams and stakeholders.
-
Vendor & Repricing Support - Assist in repricing and cost containment efforts by ensuring accurate and complete data entry
