UW HEALTH JOB DESCRIPTION Payment Poster/EDI Specialist Job Code: 07182 Mgt. Approval:
Date:
FLSA Status: HR Approval:
Date: October 2006
JOB SUMMARY Under the direct supervision of the Payment Posting Supervisor, the Payment Poster/EDI Specialist is responsible for the accurate and timely processing and posting of all incoming payments and rejections of payment from insurance companies, patients, and third party payers to customer accounts. This position verifies and researches account information, making adjustments as necessary to ensure proper filing of supplemental claims to insurance companies. The staff in this position works closely with other UW Health Departments and financial institutions to assure proper manual and electronic posting of payments and rejections for cash balancing. There are other clerical tasks which may be assigned. MAJOR RESPONSIBILITIES 1. Manually post insurance, third party, capitated, personal, charge card, Health Savings Account (HRA/HSA) payments, recoupments and rejections to the computer system; close and process payment/rejection batches. 2. Manually post department transfer payments from UWHC, Gateway and DFM sites; close and process batches. 3. Manually post EDI remittance error reports; close and process batches. 4. Manually post Special Billing payments; close and process batches (transplant, infertility, company, ect.). This process involves posting the appropriate and relevant payments to a separate account and determines how to post the payment by coverage and account type. 5. Process and accept EDI electronic remittance files through Epic Text and Epic Hyperspace. 6. Run EDI check total and remittance error reports through Epic Text. 7. Reconcile remittance work queues and accept the remittance runs through Epic Hyperspace. 8. Reconcile special finance holding accounts within three days after month end. Email Finance the dollar amounts that were reconciled. 9. Use the Finance electronic funds transfer (EFT) spreadsheet to balance electronic and manual posting for those payers from whom we receive EFT. 10. Post personal and insurance refunds when there is a backlog. Verify accuracy by running the refund error and success reports. Work closely with Finance regarding refund issues. 11. Recognize and report errors by contracted and non-contracted insurance carriers by posting the correct remit code to facilitate account work queue follow up by the product teams. Recognize and report to your supervisor, incorrect payment trends and wrong discounts with EOB examples. 12. Recognize incorrect registration when posting payments/rejections and take appropriate action to facilitate account work queue follow up by the registration staff. 13. Resolve posting errors transferred to the payment posting error account work queue, brought to your attention by your supervisor or team leader 14. Make account comments to clarify actions taken to reconcile outstanding posting issues. 15. Communicate with EDI payers regarding checks that have not been received but are listed in the remittance file. 16. Communicate with Business Office Teams, insurance companies, third party payers and others. 17. Maintain knowledge of insurance and medical terminology. 18. Maintain knowledge of Standard ANSI Codes, adjustment and in house remit codes. 19. Maintain knowledge of insurance payer/plans. 20. Maintain knowledge and follow HIPAA regulations. 21. Maintain knowledge of Kronos and Group Wise systems. 22. Maintain/exceed team productivity standards of 3000 transactions in a 40 hour week. 23. Provide training to payment posting staff relating to posting payments and rejections manually and electronically. Provide trainee and supervisor with training and progress notes. 24. Provide training to the payment posting clerk II relating to posting rejections. Provide trainee and supervisor with training progress notes. 25. Provide training and assistance to Business Office staff relating to payment posting, questions, correction of errors and missing payments. 26. Help with the clerical lockbox process when necessary. 27. Prepare lockbox and not lockbox payment batches by breaking down to smaller batches by deposit date, check and remits. 28. Alert supervisor or lockbox clerks of possible banking encoding errors. 29. Rotating responsibility for balancing payments posted to the daily bank check summaries. 30. Work with Finance to resolve charge back inquiries from charge card companies. 31. Perform general clerical duties and special projects as assigned. Prepare daily log sheet. 32. Update the daily status payment spreadsheet.
UW HEALTH JOB DESCRIPTION 33. Update training manual documentation and add new processes as necessary. 34. Follow month and year end expectations and guidelines. 35. Attend and participate in meetings as necessary.
ALL DUTIES AND REQUIREMENTS MUST BE PERFORMED CONSISTENT WITH THE UW HEALTH PERFORMANCE STANDARDS. JOB REQUIREMENTS Education
Minimum Preferred
Work Experience
Minimum Preferred Licenses & Certifications Minimum Preferred Required Skills, Knowledge, and Abilities
High School Diploma or equivalent 3-5 years medical/insurance billing experience Payment posting data entry experience in the medical field
Knowledge of reading and explanation of medical benefits (EOB) and of CPT codes Knowledge of electronic payment remittances (EDI) process Knowledge of third party payers, and a thorough understanding of their processes and payment practices Knowledge of Standard PC and Standard PC operating systems sufficient to operate and troubleshoot Knowledge of Word Knowledge of Excel Good math skills; ability to calculate fractions, decimals and percentages Good verbal and written skills Good organizational skills
AGE SPECIFIC COMPETENCY (Clinical jobs only) Identify age-specific competencies for direct and indirect patient care providers who regularly assess, manage and treat patients.
Instructions: Indicate the age groups of patients served either by direct or indirect patient care by checking the appropriate boxes below. Next, Infants (Birth – 11 months)
X
Adolescent (13 – 19 years)
Toddlers (1 – 3 years) Preschool (4 – 5 years) School Age (6 – 12 years)
X X X
Young Adult (20 – 40 years) Middle Adult (41 – 65 years) Older Adult (Over 65 years)
JOB FUNCTION Review the employee’s job description and identify each essential function that is performed differently based on the age group of the patient.
PHYSICAL REQUIREMENTS Indicate the appropriate physical requirements of this job in the course of a shift. Note: reasonable accommodations may be made available for individuals with disabilities to perform the essential functions of this position.
Physical Demand Level
X
Sedentary: Ability to lift up to 10 pounds maximum and
Occasional
Frequent
Constant
Up to 33% of the time
34%-66% of the time
67%-100% of the time
Up to 10#
Negligible
Negligible
Up to 20#
Up to 10# or requires significant walking or standing, or requires pushing/pulling of arm/leg controls
Negligible or constant
10-25#
Negligible-10#
occasionally lifting and/or carrying such articles as dockets, ledgers and small tools. Although a sedentary job is defined as one, which involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.
Light: Ability to lift up to 20 pounds maximum with frequent lifting and/or carrying of objects weighing up to 10 pounds. Even though the weight lifted may only be a negligible amount, a job is in this category when it requires walking or standing to a significant degree.
Medium: Ability to lift up to 50 pounds maximum with
20-50#
push/pull of items of negligible weight
UW HEALTH JOB DESCRIPTION frequent lifting/and or carrying objects weighing up to 25 pounds. Heavy: Ability to lift up to 100 pounds maximum with frequent lifting and/or carrying objects weighing up to 50 pounds. Very Heavy: Ability to lift over 100 pounds with frequent lifting and/or carrying objects weighing over 50 pounds.
List any other physical requirements or bona fide occupational qualifications:
50-100#
25-50#
10-20#
Over 100#
Over 50#
Over 20#
Physical Activity: Primary working position-sitting, with occasional standing, walking, stooping, crouching, and kneeling; frequent reaching, carrying, lifting, pushing, pulling, fingering, grasping, typing, talkingspeaking clearly, hearing-conversation, and seeing-near Work/Environmental: Moderate noise level consistent with an office environment Personal/Physiological: Interaction with people, working around people, planning of activities, making judgements in emergency situations, frequent changes in duties and volume of work, intraorganizational communication
