Health Claims Collections Specialist II

Orthofix

1d•$23 - $26

About The Position

The Specialist II, Health Claims Collections is responsible for resolving complex post-payment and denied DME claims. Operating within a wing-to-wing revenue cycle management team, this role takes ownership of highly escalated accounts, advanced appeals, payer trend analysis, and cross-functional issue resolution. The Specialist II, Health Claims Collections serves as a subject matter resource of junior collectors and assists leadership in driving payer compliance and revenue recovery.

Requirements

High School Diploma or Equivalent
Minimum 2+ years of medical collection or revenue cycle experience with emphasis on post-billing DME or orthopedic claims.
Advanced knowledge of payer guidelines, revenue cycle management, and appeals processes (Medicare, Medicare advantage, Medicaid, and commercial insurance payers).
Proficiency in reading and interpreting EOBs, payer policies, LCDs, and prior authorization requirements.
Strong working knowledge of ICD-10, HCPCS and billing procedures for CMS-1500 claim forms.
Proficient in Microsoft Office and medical billing platforms.
Demonstrated experience with complex denials, payer escalations, and appeals at all levels.
Strong attention to detail with the ability to identify trends and implement corrective strategies.
Excellent communication skills and negotiation skills with payers and internal stakeholders.
Ability to work independently, Detail-oriented with a focus on accuracy, time-management and compliance.
Familiarity with Oracle or similar revenue cycle platforms.

Nice To Haves

Associate’s degree preferred

Responsibilities

Independently manage a portfolio of high-priority and complex claims requiring advanced solutions and strategies.
Analyze denials, overpayments and underpayments to determine root cause; execute appropriate action plans including appeals, escalations and payer outreach.
Submit technical, clinical and medical necessity appeals at all levels (including external reviews) with supporting documentation.
Research payer contract language, LCD/NCD guidelines and policy updates; apply findings to claims resolution and communicate relevant changes to peers and leadership.
Identify payer trends (example, systemic rejections, denials, overpayments or underpayments) and escalate issues with supporting data to payer contacts and leadership.
Resolve escalated issues involving prepay audits, refund requests, rebills, recoupments and coordination of benefits discrepancies.
Manage HCFA returns and claim corrections, ensuring clean resubmission per billing guidelines.
Communicate effectively with leadership and cross-functional teams to resolve multifaceted claim barriers.
Ensure account documentation is accurate, detailed, and audit ready across all internal system.
Consistently meet or exceed departmental metrics related to productivity, quality, aging resolution, and cash recovery.