Primary Functions

1. Payment Processing & Posting

· Post payments from insurance companies, government programs (Medicare/Medicaid), and

patients into the RCM system.

· Process Electronic Remittance Advices (ERA) and Manual Explanation of Benefits (EOB).

· Apply necessary adjustments, refunds, and write-offs per payer guidelines.

· Balance and reconcile daily deposits with posted payments.

2. Denial Management & Reconciliation

· Identify and post insurance denials while ensuring timely follow-up for resolution.

· Work with the billing and accounts receivable teams to correct claim errors and resubmit

claims.

· Track underpayments and escalate discrepancies to the RCM Manager.

3. Reporting & Documentation

· Maintain accurate payment records and reconciliation reports.

· Generate daily, weekly, and monthly reports on payment trends, denials, and discrepancies.

· Ensure compliance with company policies and industry regulations (HIPAA, Medicare

guidelines).

4. Communication & Collaboration

· Coordinate with the billing team, accounts receivable, and insurance companies to resolve

Payment discrepancies.

· Respond to inquiries from internal teams regarding posted payments.

· Escalate unresolved payment issues to the appropriate leadership.