Objective :

Process Electronic Remittance Advices (ERAs) and Explanation of Benefits (EOBs) to ensure accurate payment posting, facilitate claim reconciliation, and maintain the financial integrity of the revenue cycle.

Key Responsibilities :

Remittance Receipt & Review

Purpose: Capture and verify incoming remittance data from payers.

Tasks :

  • Retrieve remittance files from:
  • Clearinghouse or payer portals (for ERAs)
  • Fax, mail, or scanned copies (for paper EOBs)
  • Confirm remittance details match expected claim submissions:
  • Payer name and identification
  • Date of service (DOS)
  • Patient and provider information
  • Payment amount and method (check or EFT)

Payment Posting :

Purpose: Accurately record payment information into the practice management or billing system.

Tasks :

  • Post payments against individual claims or line items.
  • Apply adjustments for:
  • Contractual write-offs
  • Co-pays, deductibles, coinsurance
  • Denied or partially paid services
  • Post zero-pay claims with associated denial reasons.
  • Reconcile EFT deposits with ERA batches for payment matching.

Denial & Variance Management :

Purpose: Identify and flag discrepancies or rejections for follow-up.

Tasks :

  • Identify denied or underpaid claims for follow-up or appeal.
  • Tag claims requiring secondary billing or coordination of benefits (COB).
  • Escalate non-payment or payer variance issues to billing or AR teams.
  • Record denial reason codes and payer remarks accurately.

Reconciliation & Reporting :

Purpose: Ensure remittance data aligns with bank deposits and patient accounts.

Tasks :

  • Reconcile posted remittances with:
  • EFT deposits
  • Daily/monthly deposit logs
  • Patient account balances
  • Generate reports on:
  • Payments received
  • Adjustments and write-offs
  • Open balances or discrepancies
  • Assist in end-of-month closeout procedures and reporting.

Our Best Practices :

  • Automate ERA processing where possible to reduce manual entry.
  • Standardize a workflow for paper EOBs vs. electronic remits.
  • Use a remittance posting checklist to verify accuracy.
  • Maintain an EFT/ERA tracking log for audit readiness.
  • Train staff on payer-specific posting rules and denial codes.

Why It’s Important :

Accurate remittance processing ensures timely revenue recognition, helps identify payer issues, supports denial management, and keeps financial records clean — all critical to a healthy revenue cycle.