Sr Process Executive

Job Summary


Responsibilities

• Payment Entry Post ERA (835) payments automatically or manually Post manual EOB payments from paper or portal Apply payments to: Charges / Adjustments / Patient responsibility Verify payment accuracy vs allowed amount
• Adjustment Posting Post contractual adjustments per payer contract Apply correct adjustment codes: CO (Contractual) / PR (Patient Responsibility) / OA (Other Adjustments) Ensure no over-adjustment or under-adjustment
• Denial Remark Code Capture Record all denial codes (CARC / RARC) Map denials correctly for denial team Flag:Zero payments / Underpayments / Medical necessity denials / Authorization denials
• Patient Payments Post: Copay / Coinsurance / Deductible / Self-pay payments Reconcile with: Front desk collections Patient portal payments Lockbox / bank deposits
• Credit Balance Identification Identify overpayments Flag refunds required Transfer credits across DOS or accounts Prevent negative A/R
• Underpayment Identification Compare: Paid amount vs contract allowed Flag: Payer underpayment Downcoding Incorrect fee schedule Bundling issues
• Exception Handling Escalate cases such as: Mismatched patient Missing claim Unapplied cash ERA without claim Negative allowed

Qualifications

• Role Overview: Role Summary: Payment Posting Executive is responsible for accurate posting of insurance and patient payments, adjustments, and denial codes into the billing system to maintain correct A/R and support revenue cycle operations.
• Educational Qualification: Any degree (Commerce / Science preferred) ; Medical billing certification (preferred) ; RCM training (advantage)
• Experience Requirement: 5+ Years
• Core Technical Skills: ERA (835) posting; EOB interpretation; Allowed vs Paid vs Adjustment; Contractual adjustments; Secondary balance transfer
• Codes Knowledge: CARC / RARC; CO / PR / OA groups; Patient responsibility components; Copay; Coinsurance; Deductible
• RCM Understanding: Claim lifecycle; Coordination of benefits; Payer sequence; Denial impact on A/R
• System Skills: Practice Management (PM) software (Can be trainable); ERA auto-posting tools; Excel basics; Clearinghouse portal navigation
• Analytical Skills: Identify underpayments; Detect posting errors; Match EOB to claim; Validate allowed amount; Spot overpayments; Flag denial patterns
• Accuracy Productivity Expectations: Accuracy: 98%; ERA lines: 1,500-3,000/day; Manual EOB/day; Zero reconciliation variance; Minimal unapplied cash
• Behavioral Competencies: Attention to detail; Numerical accuracy; Process discipline; Consistency; Accountability; Time management
• Advanced Competencies (Senior Poster): Reconciliation expertise; Complex payer EOB interpretation; Cross-DOS credit transfer; Contract variance analysis; Training juniors; QA auditing

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