Job Description

Job Description

Job Description

Job Objective :

Under the direction of the Vice President of Revenue Cycle or designee, the Explanation of Benefits (EOB) Reviewer ensures all that all Commercial and Managed Care payments and adjustments are posted correctly, and that the balance is moved to the next payor or underpayment bucket accurately and timely. Post electronic remittance advices and patient payments. Assists the Account Receivable Specialist with other types of posting within the Cash Poster's skill sets and abilities.

Duties and Responsibilities:

A. Electronic Remittance Advice (ERA) Posting

1. 1. Post ERAs from, but not limited to, Medicare, Medi-Cal, and Blue Cross
   2. Review and validate ERA transactions for posting accuracy or discrepancies B. Check Posting
   1. Post patient payments
   2. Post zero payments from insurance explanation of benefits (EOBs)
   3. Post other payment sources as assigned

C. Other Responsibilities

1. 1. Document account information at time of posting
   2. Prepare contractual batch totals to be reconciled with processed checks

D. Others

1. 1. Verify that all payments and adjustments are posted to correct insurance plan
   2. Verify that payments are paid per the terms of the contract and adjust balances, as needed
   3. Assign and forward all under-paid accounts to the Appeals Department
   4. Move balances and/or queue secondary claims, as needed
   5. Move remaining balance to self-pay, as appropriate
   6. Assist with posting zero payment EOBs, as needed
   7. Ensure if Insurance over paid that it is assigned as a true credit.
   8. Pull supporting documents for annual regulatory audits, as needed
   9. Other duties as assigned, within skillsets and abilities.

Knowledge

Working knowledge of HMO, PPO, and Commercial reimbursement

Working knowledge of Managed Care contract language and interpretation

Technical knowledge of all reimbursement methodologies, APC, DRG, Per Diem, etc.

1. Other Responsibilities
   1. Document account information at time of posting
   2. Prepare contractual batch totals to be reconciled with processed checks

Abilities

Strong analytical and math skills

Ability to work in a fast-paced team environment, as well as independently

Ability to remain professional and courteous at all times, regales of the situation

Education

High School graduate or equivalent

Experience

Minimum 1-year previous Commercial, HMO and PPO insurance follow-up experience

Previous EOB Reviewer experience, preferred

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