Revenue Cycle Specialist - Orthopedic Care

Job Summary

Required Qualifications

• •deep expertise with multi state telehealth and in-person claim submission
• •copays
• •payment posting
• •insurance guidelines
• •revenue cycle workflows that ensure we are reimbursed accurately and on time
• •Track, analyze, and appeal payer claim denials through structured denial management workflows to recover lost revenue and identify systemic adjudication trends
• •Monitor payer contract performance and fee schedules to audit for underpayments and ensure accurate reimbursement according to negotiated terms
• •Calculate and collect up-front patient financial responsibility utilizing real-time eligibility tools
• •Reconcile underpayments against specific payer contract fee schedules, auditing high-reimbursement cases to ensure contractual rates for supplies, procedures, and instrumentation are paid in full
• •Ensure that all Reimbursements for medical services or supplies are provided to a qualified beneficiary, medically reasonable and necessary, performed by a qualified practitioner (within the scope of their practice) and coded accurately (procedures and diagnosis) in accordance with the documented medical record
• •Determine the root cause of billing errors and act to prevent any recurrence, retrain on coding practices as needed and review policies and procedures for clarity of expectations and requirements
• •Provide timely overpayment refunds to the payor in compliance with associated federal or state funded healthcare program payor requirements
• •Continuously enhance skills and knowledge in compliance coding and billing training to minimize potential risk of receiving improper payments
• •Participate in coding reviews and monitoring of coding practices
• •Regularly participate in internal audits to verify that billing updates have been properly integrated and adhered to across all claims and address discrepancies with corrective actions as needed
• •Stay up-to-date on coding, reimbursement, and regulatory changes to ensure accurate claims, compliance, and efficient revenue management
• •Ensure that collections and accounts receivable (AR) management processes adhere to federal and state regulations, safeguard patient information, and maintain financial integrity
• •Maintain and enforce a billing and receivables framework that maintains compliance, ensures accurate reimbursement, protects patient privacy, and optimizes cash flow

Desired Qualifications

• •Degree, certificate, or diploma in medical billing, health information management, or healthcare administration preferred
• •Completion of a medical billing training program preferred
• •Certified Professional Biller (CPB) a major plus
• •Exceptional communication skills to interact with patients, healthcare providers, and insurance companies
• •Unmatched attention to detail to ensure claims are processed timely and correctly, and that payments are received
• •Ability to manage multiple tasks and prioritize effectively
• •Ability to use multiple digital tools for billing, record keeping and patient care directive