Job Description
Payments & Credits Representative
Position Summary
This role is responsible for accurate and timely payment posting, reconciliation, and credit balance resolution for a high-volume urgent care environment. This role performs EFT/bank reconciliation, ERA and lockbox payment posting, missing payment investigation, chargeback processing, and the preparation and posting of refunds and recoupments. This role plays a critical role in maintaining financial integrity, minimizing unapplied cash, and ensuring compliance with payer contracts and internal controls.
Key Responsibilities
Payment Posting
Post payer remittances accurately and timely using ERAs (835 files) and manual posting as needed.
Process lockbox payments and ensure proper allocation to patient accounts.
Apply contractual adjustments, denials embedded in ERAs, and payer remark codes accurately.
EFT, Bank & Deposit Reconciliation
Reconcile EFT/ACH deposits to ERA files, clearinghouse reports, and bank statements.
Identify and resolve discrepancies between posted payments and bank deposits.
Research and resolve unapplied or unidentified cash.
Missing Payment & Underpayment Investigation
Identify missing, partial, or misapplied payments.
Conduct research using payer portals, remittance reports, and bank data to locate payments.
Coordinate with A/R Follow-Up, payers, and clearinghouses to resolve issues.
Credit Balance Resolution
Identify and analyze credit balances on payer and patient accounts.
Reallocate, offset, or prepare credits for refund in accordance with payer contracts and organizational policy.
Chargebacks, Refunds & Recoupments
Process patient-initiated charge backs by reviewing disputed funds and completing necessary actions to prevent lost collections
Process payer take-backs, and recoupments accurately and timely.
Prepare and post patient and payer refunds following approval workflows and internal controls.
Documentation, Compliance & Quality
Document payment and reconciliation activities accurately in the billing system.
Adhere to CMS regulations, payer contracts, HIPAA requirements, and internal financial controls.
Participate in quality assurance audits and required training.
Collaboration & Continuous Improvement
Collaborate with Billing, A/R Follow-Up, Patient Billing, and Finance teams to resolve payment- related issues.
Identify recurring issues and process gaps and escalate trends to the Supervisor.
Required Qualifications
High school diploma or equivalent required; Associate degree in Accounting, Finance, or Healthcare Administration preferred.
1–3 years of experience in healthcare payment posting, reconciliation, or credit balance operations.
Working knowledge of ERA/EFT processing, remittance advice interpretation, and reconciliation processes.
Experience using EHR/practice management systems, clearinghouses, and payer portals.
Preferred Qualifications
Experience in urgent care or high-volume ambulatory billing environments.
Familiarity with California payer requirements and refund regulations.
Certification such as CRCR, CPB, or relevant finance-related credential (or progress toward certification).
Key Competencies
High attention to detail and financial accuracy
Strong analytical and reconciliation skills
Ability to manage repetitive, high-volume tasks efficiently
Clear written and verbal communication
Team-oriented and compliance-focused mindset
Working Conditions
Office or remote environment; flexibility for onsite work dictated by business needs