Medical Claims Payment Posting, Reconciliation & Reporting Specialist

The Role:

The Medical Claims Payment Posting, Reconciliation & Reporting Specialist is responsible for accurately posting insurance payments, reconciling daily deposits, resolving payment discrepancies, and generating financial and operational reports. This role ensures the integrity of revenue cycle processes and supports the organization’s financial performance through precise payment management and analysis.

Key Responsibilities:

1. Payment Posting

• Accurately post insurance claim payments, adjustments, and denials into the practice management or billing system.
• Review and interpret Explanation of Benefits (EOBs), Electronic Remittance Advices (ERAs), and correspondence from payers.
• Apply correct contractual adjustments and identify underpayments, overpayments, or missing payments.
• Process payment batches and reconcile payment uploads to bank deposits.

2. Reconciliation

• Perform daily reconciliation of posted payments against bank statements and deposits.
• Investigate discrepancies between posted amounts and actual payments; escalate unresolved variances as needed.
• Maintain accurate logs of deposits, remittances, and reconciliation summaries.
• Conduct monthly reconciliation for internal financial reporting requirements.

3. Denial and Issue Resolution

• Identify claim denials, partial payments, or payer inconsistencies.
• Communicate with billing team members or payers to resolve payment issues.
• Track recurring denial trends and recommend corrective actions to improve clean-claim rates.

4. Reporting

• Produce daily, weekly, and monthly payment and reconciliation reports.
• Generate operational reports such as payment trends, payer performance, denial summaries, and accounts receivable insights.
• Provide analysis supporting month-end closing and financial reviews.
• Assist leadership with customized reporting requests.

5. Compliance & Documentation

• Ensure compliance with HIPAA, payer guidelines, and internal financial protocols.
• Maintain accurate and organized documentation of payments, remittances, and reconciliation records.
• Support audit requests by supplying detailed payment and reporting documentation.

Qualifications

• High school diploma or equivalent; associate degree or business/healthcare coursework preferred.
• 3-5 years of experience in medical billing, payment posting, or healthcare revenue cycle operations.
• Strong knowledge of ERAs, EOBs, CPT/ICD-10 codes, and insurance payer processes.
• Proficiency with billing systems (e.g., Epic, Athena, NextGen, eClinicalWorks, Kareo) and Excel/Google Sheets.
• Excellent attention to detail, analytical skills, and ability to work independently with high accuracy.
• Strong communication and problem-solving skills.

Core Competencies

• Accuracy & attention to detail
• Revenue cycle understanding
• Analytical thinking
• Time management & multitasking
• Financial reconciliation
• Data reporting & interpretation
• Confidentiality & compliance awareness