Sr Process Executive

Job Summary

Position Title: Senior Process Executive

Experience: 3+ Years

Roles and 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

Candidate Profile

• 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).
• Educational Qualification: Medical billing certification (preferred).
• Educational Qualification: RCM training (advantage).
• Experience Requirement: 5+ Years
• Core Technical Skills: Payment Knowledge
• Core Technical Skills: Codes Knowledge
• Core Technical Skills: RCM Understanding
• System Skills
• Analytical Skills: Candidate should be able to:
• Accuracy Productivity Expectations
• Behavioral Competencies
• Advanced Competencies (Senior Poster)
• Complex EOB handling
• Reconciliation
• Underpayment identification
• Credit balance handling
• QA auditing
• ERA (835) posting
• EOB interpretation
• Allowed vs Paid vs Adjustment
• Contractual adjustments
• Secondary balance transfer
• CARC / RARC
• CO / PR / OA groups
• Patient responsibility components
• Copay
• Coinsurance
• Deductible
• Claim lifecycle
• Coordination of benefits
• Payer sequence
• Denial impact on A/R
• Practice Management (PM) software (Can be trainable)
• ERA auto-posting tools
• Excel basics
• Clearinghouse portal navigation
• Identify underpayments
• Detect posting errors
• Match EOB to claim
• Validate allowed amount
• Spot overpayments
• Flag denial patterns
• Accuracy: 98%
• ERA lines: 1,500 3,000/day
• Zero reconciliation variance
• Minimal unapplied cash
• Attention to detail
• Numerical accuracy
• Process discipline
• Consistency
• Accountability
• Time management
• Reconciliation expertise
• Complex payer EOB interpretation
• Cross-DOS credit transfer
• Contract variance analysis
• Training juniors

Disclaimer: This job posting has been aggregated from external source. Role details, content, and availability are subject to change. Applicants are advised to confirm the latest information directly on the company website before applying.