Medical Billing Specialist for Orthopedic Medical Group
About The Position
Manages the end-to-end debt collection process for all assigned payer accounts within the Accounts Receivable (AR) portfolio. Initiates patient outreach as needed to obtain updated demographic or insurance information, and to discuss outstanding balances and patient financial responsibility. Proactively addresses claim rejections, perform necessary corrections and rebilling, follows up on partial payments, non-responses, and initiates appeals as appropriate. Engages with payers via phone or other channels to ensure timely and accurate resolution of claims. Reviews and disputes payment variances in accordance with payer contracts, ensuring compliance and optimal reimbursement. Maintains comprehensive documentation of all communications and activities in the electronic medical record (EMR) system. Collaborates with clinic staff and leadership to identify and escalate denial trends, contributing to root cause analysis and process improvement. Partners with management to develop and implement strategies to prevent denials and improve collections. Serves as a resource to staff, management, and leadership by addressing questions related to assigned payers, trends, and claim resolution. Provides timely reports to management on denial patterns and payer issues to support operational decision-making. Follows up on unresolved payer issues to ensure complete resolution and appropriate follow- through. Perform adjustments to uncollectible balances in accordance with departmental policies and sound judgment. Submits required documentation and progress notes to payers to support claims and appeals as needed. Maintains strict confidentiality and compliance with HIPAA regulations in handling Protected Health Information (PHI). Ensures compliance with all applicable federal, state, and local regulations, as well as internal company policies and procedures. Completes all other billing tasks assigned
Requirements
- Strong action and results focus, self-management and the ability to prioritize and track multiple time sensitive activities and projects simultaneously
- Excellent problem-solving skills and strong communication skills, both written and verbal.
- Respects patients by recognizing their rights; maintaining confidentiality.
- Ability to work onsite in the billing department
- Performs other duties as assigned
- Onsite schedule Monday-Friday
- Strong communication skills
- Above average critical thinking skills
- Customer service experience
- Experience with basic computer programs
- Knowledge and understanding of Commercial, IPA and Government payers
- Knowledge of standard claims evaluation techniques, references and settlements
- Requires prolonged sitting, frequent mobility, and some bending, stooping, and stretching.
- Requires manual dexterity sufficient for and proficiency in the use of office machines such as telephone, computers, copier/fax machine, and other equipment as necessary.
- Require vision and hearing within a normal range.
- Lifting of up to 30 pounds.
Responsibilities
- Manages the end-to-end debt collection process for all assigned payer accounts within the Accounts Receivable (AR) portfolio.
- Initiates patient outreach as needed to obtain updated demographic or insurance information, and to discuss outstanding balances and patient financial responsibility.
- Proactively addresses claim rejections, perform necessary corrections and rebilling, follows up on partial payments, non-responses, and initiates appeals as appropriate.
- Engages with payers via phone or other channels to ensure timely and accurate resolution of claims.
- Reviews and disputes payment variances in accordance with payer contracts, ensuring compliance and optimal reimbursement.
- Maintains comprehensive documentation of all communications and activities in the electronic medical record (EMR) system.
- Collaborates with clinic staff and leadership to identify and escalate denial trends, contributing to root cause analysis and process improvement.
- Partners with management to develop and implement strategies to prevent denials and improve collections.
- Serves as a resource to staff, management, and leadership by addressing questions related to assigned payers, trends, and claim resolution.
- Provides timely reports to management on denial patterns and payer issues to support operational decision-making.
- Follows up on unresolved payer issues to ensure complete resolution and appropriate follow- through.
- Perform adjustments to uncollectible balances in accordance with departmental policies and sound judgment.
- Submits required documentation and progress notes to payers to support claims and appeals as needed.
- Maintains strict confidentiality and compliance with HIPAA regulations in handling Protected Health Information (PHI).
- Ensures compliance with all applicable federal, state, and local regulations, as well as internal company policies and procedures.
- Completes all other billing tasks assigned
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
