Insurance Follow-Up Representative-Surgical Collections

Healthcare Outcomes Performance Co. (HOPCo)•Royal Palm Beach, FL

10h•Onsite

About The Position

Center for Bone & Joint Surgery is seeking an experienced, results-driven Insurance Follow-Up Representative to join its Revenue Cycle team. This full-time, onsite position manages complex surgical accounts receivable, resolves claim denials and appeals, secures appropriate reimbursement, and supports revenue recovery for orthopedic surgical services. The role works with patients, providers, staff, and insurance carriers while maintaining productivity and quality standards and following company policies and Revenue Cycle procedures. The organization is a multi-location medical practice focused on diagnosing and treating musculoskeletal injuries and diseases. Its services include on-site X-ray, MRI, and physical therapy.

Requirements

Minimum 2 years of experience in medical billing, collections, insurance follow-up, or revenue cycle management.
Strong experience with orthopedic surgical billing, denial management, and appeals.
Demonstrated success recovering revenue from complex surgical claims across multiple payer types.
Working knowledge of surgical coding, global periods, bundling edits, modifiers, and payer reimbursement methodologies.
Excellent written and verbal communication skills to interact effectively with insurance representatives, providers, and patients.
Strong analytical, organizational, and problem-solving skills, with exceptional attention to detail.
Advanced understanding of ICD-10-CM, CPT, surgical modifiers, and orthopedic coding guidelines.
Knowledge of physician billing processes and payer-specific reimbursement policies.
Experience with healthcare billing systems.
Advanced computer skills, including proficiency in Microsoft Windows-based applications.
Strong knowledge of insurance claims processing, denial management, appeals, reimbursement methodologies, and accounts receivable follow-up.

Nice To Haves

Certified Professional Coder (CPC), CCS, or equivalent certification preferred.
Experience with Athena EMR and billing platforms is highly preferred.

Responsibilities

Review and resolve complex surgical claim denials, underpayments, and rejections by identifying root causes and carrying out appeal strategies.
Analyze denied and unpaid orthopedic surgical claims and submit supporting appeals to maximize reimbursement.
Verify patient demographic information, insurance eligibility, and coordination of benefits; update records as needed.
Confirm claim receipt with insurance carriers and monitor claim status to facilitate timely payment.
Research and obtain documentation, operative reports, medical records, referrals, and authorizations needed to support claim adjudication and appeals.
Interpret and apply payer-specific reimbursement guidelines, medical necessity requirements, and billing policies.
Review coding, modifiers, and claim edits for compliance with CPT, ICD-10, and payer-specific billing requirements.
Take ownership of assigned accounts receivable and proactively work aging accounts to reduce outstanding balances.
Analyze accounts for accurate claim processing and payment posting, and respond to inquiries from patients, providers, and staff.
Identify denial trends, payer issues, and revenue cycle opportunities and communicate findings to leadership.
Maintain productivity and quality standards while following company policies and Revenue Cycle procedures.

Benefits

Competitive health and welfare benefits available after 30 days of service.
Monthly $43 stipend to apply toward ancillary benefits.
Health Savings Account (HSA) with qualifying HDHP plans and company contributions.
401(k) plan with company match.
Employee Assistance Program (EAP) available 24/7.
Paid Time Off (PTO).
Paid holidays.
No evening or weekend work.
Business hours Monday–Friday, 8 a.m.–5 p.m.

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