RCM Payment Entry Specialist

Position Summary

The Payment Entry Specialist handles advanced and complex payment posting functions including high-dollar remittances, multi-claim EOBs, complex coordination of benefits payments, and escalated reconciliation variances. This role serves as the technical expert within the payment posting team, mentoring junior staff, leading quality audits, and driving process efficiencies to improve posting accuracy and turnaround.

Essential Duties And Responsibilities

Post complex, high-dollar, and multi-claim remittances requiring advanced knowledge of coordination of benefits, capitation payments, and bundled payment arrangements. Resolve escalated payment posting discrepancies, including misapplied payments, unidentified cash, and complex take-back scenarios. Perform secondary and tertiary payment posting with proper balance transfer and patient responsibility calculation. Conduct quality audits on payment entries processed by team members, identifying patterns and providing corrective coaching. Mentor and train junior payment entry staff on posting workflows, payer contract interpretation, and reconciliation procedures. Analyze posting error trends and unapplied cash aging, preparing reports and recommending corrective actions to leadership. Manage month-end and quarter-end reconciliation close activities, ensuring all outstanding items are resolved. Serve as escalation point for payer recoupment disputes, offset resolution, and complex refund scenarios. Maintain and update payment posting SOPs, payer-specific posting guides, and quick-reference materials. Support system testing for billing platform upgrades and ERA/835 integration changes. Ensure compliance with HIPAA, CMS, and organizational financial policies.

Qualifications

Required

• Associate's degree in HIM, Healthcare Administration, Accounting, or related field; Bachelor's.
• 1–3 years of progressive experience in healthcare payment posting or revenue cycle operations.
• Advanced knowledge of ERA/EOB interpretation, CARC/RARC codes, coordination of benefits, and payer contract terms.
• Experience handling complex multi-payer and high-dollar remittances.
• Proficiency in billing systems and clearinghouse platforms.
• Demonstrated mentoring ability and quality improvement experience.
  
  

Preferable

• CPC, CRCR, or RHIT certification.
• Experience with capitation, bundled payments, and value-based reimbursement posting.
• Familiarity with revenue cycle analytics and KPI dashboard reporting.
• Prior experience in hospital-based or multi-specialty payment environments.
  
  

Benefits

Veradigm believes in empowering our associates with the tools and flexibility to bring the best version of themselves to work. Through our generous benefits package with an emphasis on work/life balance, we give our employees the opportunity to allow their careers to flourish.

• Quarterly Company-Wide Recharge Days
• Peer-based incentive Cheer awards
• Tuition Reimbursement Program
  
  

To know more about the benefits and culture at Veradigm, please visit the links mentioned below: -

https://veradigm.com/about-veradigm/careers/benefits/

https://veradigm.com/about-veradigm/careers/culture/

Veradigm is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse and inclusive workforce.

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