Medical Billing Specialist

Join Our Thriving Pediatric Orthopaedic Group!

Are you a detail-oriented insurance collector passionate about ensuring accurate billing in a fast-paced environment? We are seeking a highly motivated Billing Specialist to join our revenue cycle management team and play a vital role in bringing patient accounts to a zero balance.

Role Overview:

In this role, you will oversee the billing process for healthcare services, ensuring accurate claim submissions and full payment collection. Your responsibilities will include reviewing rejected claims, making justified adjustments, handling appeals for denied or underpaid claims, creating monthly Accounts Receivable reports, and resolving issues with provider representatives.

What You'll Do:

• Independently:
  • Analyze claim denials and take corrective action, including corrected claims, reconsiderations, and appeals.
  • Apply accurate adjustments based on insurance guidelines and contracts.
  • Manage secondary insurance and patient responsibility.
• Collaboratively:
  • Work closely with the team to resolve outstanding insurance payments. This includes pulling insurance policies and setting up system edits and scrubs to prevent future denials.
  • Correspond with Insurance Verification and Front Desk to input missing data and correct registration errors.
  • Communicate effectively with patients and front desk regarding balances and collect payments.

Daily Responsibilities:

• Claims Management: Analyze and resolve rejected claims, ensuring accurate coding and modifiers per COSSA and payer policies.
• Appeals Process: Research, prepare, and submit appeals for denied or underpaid claims. Draft detailed justification letters supported by documentation and payer policies.
• Collaboration: Coordinate with charge entry personnel and revenue cycle specialists to ensure accurate claim processing and resubmission. Work with providers to optimize appeals and validate adjustments.

Work Environment: On-site (St. Petersburg or Tampa Office Location)

Team Dynamics: Join a high-functioning team that values collaboration, communication, flexibility, and a positive attitude. We seek individuals who contribute positively to team dynamics and foster a supportive work environment.

Cultural Fit and Team Development:

We value:

• Patient-Focused Care: Prioritizing patient needs and well-being.
• Competence: Maintaining high standards and pursuing certification within 2 years.
• Credibility: Acting with integrity and honesty.
• Innovation: Embracing new ideas to enhance workflows.
• Employee Recognition: Valuing individual contributions.

We are committed to the continuous development of our team members by offering opportunities for professional growth, ongoing learning, and skill enhancement through regular feedback, mentorship, and targeted training.

Training Period: New hires are required to complete a 90-day training period to familiarize themselves with our processes and integrate with the team.

Work Hours: Standard department hours are from 8:30 AM to 5:00 PM.

Salary and Benefits:

• Health Benefits: 95% employee premium coverage for Medical (UHC), Dental (Delta), and a $20,000 life insurance policy with no payroll deductions. Coverage starts the first day of the month after your 30-day anniversary.
• Paid Time Off: 16 days of PTO and 5 days of SD/Serious Illness accrued in the first year.
• Profit Sharing: Employer contributions begin after one year, with a historical rate of at least 14% annually. No payroll deductions for retirement savings, with vesting 20% annually over five years.
• 401K & Roth 401K: Employee contribution plan

Ready to grow your career with a dynamic team? Apply today!

Requirements

• Minimum of 2 years' experience as a medical revenue cycle
• Proven track record in AR follow-up, EDI management, coding, medical terminology, and computer skills.
• CPC or CPB certification (or willingness to obtain within 2 years - employer paid).

What would make you stand out?

• Experience in insurance verification and pediatrics/orthopaedics.
• Familiarity with AthenaPractice, Encoda, or Phreesia.
• Knowledge of Florida Medicaid.

Billing companies need not apply. We have a high functioning team and have no need to outsource.