RCM Payment Resolution & Correspondence Specialist

RCM - Payment Resolution & Correspondence Specialist

Job Summary:

The RCM - Payment Resolution & Correspondence is responsible for the daily management of the AthenaOne Unpostable Dashboard and Correspondence Dashboard. This position ensures timely research and resolution of unapplied payments, payer correspondence, and documentation requests to optimize cash flow, reduce accounts receivable, and support timely claim adjudication.

The specialist serves as the subject matter expert for payment exception management and correspondence workflows, partnering with Payment Posting, Billing, Denials, Finance, Managed Care, and Practice Operations to resolve payment discrepancies and payer inquiries. This role is instrumental in maintaining the integrity of the revenue cycle by minimizing unapplied cash, reducing correspondence backlogs, and identifying opportunities for process improvement.

(This is a full time position that will support our team at SouthPark Monday to Friday, 8 am to 5 pm)

Primary Job Responsibilities:

• Manage the AthenaOne Unpostable Dashboard daily to research and resolve unapplied insurance and patient payments.
• Manage the AthenaOne Correspondence Dashboard to ensure timely processing of payer requests and claim-related correspondence.
• Research payment discrepancies using ERAs, EOBs, EFTs, clearinghouse reports, bank deposits, payer portals, and AthenaOne.
• Apply, transfer, reverse, or adjust payments as appropriate to ensure accurate account reconciliation.
• Partner with internal departments and insurance carriers to resolve payment exceptions and correspondence issues.
• Maintain accurate documentation of all research and resolution activities within AthenaOne.
• Monitor work queue aging and prioritize accounts to meet organizational turnaround standards and payer filing deadlines.
• Identify recurring trends contributing to unapplied payments or correspondence delays and recommend process improvements.
• Ensure compliance with HIPAA, CMS regulations, payer requirements, and organizational policies.

Minimum Qualifications

• High school diploma or GED required; associate's degree in healthcare administration, Business, Accounting, or related field preferred.
• Minimum of 2-4 years of healthcare Revenue Cycle experience, with emphasis in payment posting, accounts receivable, billing, denials, or cash management.
• Experience working within an electronic practice management system; AthenaOne experience strongly preferred.
• Working knowledge of medical billing, insurance claims processing, and payment posting workflows.
• Experience researching and resolving insurance payment discrepancies.

Preferred Qualifications

• Experience managing AthenaOne Unpostable and/or Correspondence Dashboards.
• Knowledge of ERA/EFT processing and electronic payment reconciliation.
• Experience with commercial, Medicare, Medicaid, and managed care payer guidelines.
• Experience utilizing payer portals and clearinghouse systems.

Knowledge, Skills & Abilities

• Strong analytical and investigative problem-solving skills.
• Excellent organizational and time management skills with the ability to prioritize multiple work queues.
• Strong understanding of healthcare reimbursement methodologies and insurance payment processes.
• Ability to interpret Explanation of Benefits (EOBs), Electronic Remittance Advice (ERAs), and payer correspondence.
• Excellent written and verbal communication skills.
• High attention to detail with strong accuracy in payment application and documentation.
• Ability to collaborate effectively with Finance, Billing, Payment Posting, Denials, Patient Financial Services, Practice Operations, and external payers.
• Ability to identify workflow inefficiencies and recommend process improvements.
• Self-motivated with the ability to work independently while meeting productivity and quality expectations.