Job Description
Job Summary Under the direct supervision of the Revenue Cycle Supervisor, this position is responsible for ensuring the timely collection of accounts receivable, monitoring account activity, and providing appropriate follow-up to maximize reimbursement for physician billing. The ideal candidate will have a strong understanding of medical claims billing, denial management, and insurance follow-up in a fast-paced healthcare environment.
Key Responsibilities - Perform collection activities, including status calls, appeals, and account reviews to ensure timely reimbursement.
- Research and resolve claims denials using appropriate internal and external resources.
- Monitor denied claims to ensure corrections or appeals are completed promptly.
- Review pre-bill claim holds to ensure claims are submitted cleanly the first time.
- Ensure appropriate and accurate information is submitted to insurance companies to expedite payment.
- Take proactive follow-up actions to secure payment on the first follow-up call or appeal whenever possible.
- Compose and submit appeals to insurance carriers for denied claims.
- Correct claims billed to incorrect insurance carriers and ensure authorizations are attached to claims.
- Handle incoming requests for information from insurance companies within 24 hours.
- Assist Financial Counselors with patient inquiries related to insurance claims.
- Collaborate with internal teams within the business office to resolve billing and reimbursement issues.
- Communicate trends, issues, and findings to the lead, supervisor, and management team.
- Comply with productivity, quality, and performance expectations established by management.
- Ensure compliance with all company plans, policies, and procedures set forth by Orthopaedic Solutions Management.
- Perform all other duties as assigned.
Education and Experience - High School Diploma or General Education Degree (GED) required.
- 2-4 years of physician office billing and denial management experience required.
- Working knowledge of ICD-10, CPT, and HCPCS coding.
- Ability to read and interpret Explanation of Benefits (EOBs).
- Knowledge of Medicare Part B, Medical Assistance, and commercial insurance products.
- Familiarity with CMS-1500 claim forms.
- Basic understanding of medical terminology and anatomy.
Preferred Qualifications and Skills - Athena billing system experience strongly preferred.
- Excellent written and verbal communication skills.
- Strong attention to detail with the ability to multitask and work independently.
- Proficient in Microsoft Office Suite and general computer applications.
- Ability to work effectively in a fast-paced, growing practice environment.
- Self-starter with strong organizational and problem-solving skills.
Orthopaedic Solutions Management is a Drug Free Workplace We are committed to maintaining a safe, healthy, and productive work environment. As part of this commitment, we operate as a drug-free workplace. All candidates will be required to undergo pre-employment drug screening and/or be subject to random drug testing in accordance with applicable laws and company policy.
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
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