Revenue Cycle Specialist

Job Summary

Under the direct supervision of the Revenue Cycle Ancillary Supervisor, this position is responsible for ensuring the timely collection of accounts receivable, monitoring account activity, and providing appropriate follow-up to maximize reimbursement for ancillary billing. The ideal candidate will have a strong understanding of medical claims billing, denial management, and insurance follow-up, while collaborating with internal teams to resolve billing issues and improve revenue cycle performance.

Job Details

Compensation: $20 an hour

Travel Requirements:

• Orientation: Must be able to attend orientation in the Tampa Bay Area
• Quarterly Meetings: Must be able to travel to the Tampa Bay area for quarterly meetings

Key Responsibilities

• Perform collection activities, including status calls, appeals, and account reviews to ensure timely reimbursement.
• Research and resolve claims denials using appropriate internal and external resources.
• Monitor denied claims to ensure corrections or appeals are completed accurately and timely.
• Review pre-bill claim holds and internal edits to ensure claims are submitted cleanly and timely.
• Ensure appropriate and complete information is submitted to insurance companies to expedite payment.
• Take proactive follow-up actions to secure payment on the first follow-up call or appeal when possible.
• Follow up on assigned cases and work queues within the organization.
• Compose and submit appeals to insurance carriers for denied claims.
• Handle incoming requests for information from insurance companies within 24 hours.
• Assist Financial Counselors with patient inquiries related to claims.
• Correct accounts billed to incorrect insurance carriers.
• Ensure required authorizations are attached to claims prior to submission.
• Meet quantity and quality performance expectations as established by management.
• Communicate trends, issues, and findings to the lead, supervisor, and team.
• Collaborate with other teams within the business office to resolve billing and reimbursement issues.
• Provide appropriate feedback to management regarding process improvements and challenges.
• Ensure compliance with all company plans, policies, and procedures set forth by Orthopaedic Solutions Management.
• Perform all other duties as assigned.

Education and Experience

• High School Diploma or GED required.
• Minimum of 24 years of medical billing, collections, or denial management experience preferred.
• Experience with ancillary billing strongly preferred.

Preferred Qualifications & Skills

• Strong knowledge of medical claims billing and reimbursement processes.
• Ability to read and interpret Explanation of Benefits (EOBs).
• Excellent written and verbal communication skills.
• Strong attention to detail and organizational skills.
• Ability to manage multiple priorities in a fast-paced environment.
• Proficient in basic computer applications and billing systems.
• Ability to work independently and collaboratively as part of a team.

Orthopaedic Solutions Management is a Drug Free Workplace

We are committed to maintaining a safe, healthy, and productive work environment. As part of this commitment, we operate as a drug-free workplace. All candidates will be required to undergo pre-employment drug screening and/or be subject to random drug testing in accordance with applicable laws and company policy.

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.