Revenue Cycle Specialist

Job Description

Job Description

JOB SUMMARY:

Under direct supervision of the Clinic Manager, this position is responsible for assuring timely collection of accounts receivable and insurances, monitoring account activity and providing adequate follow up to ensure maximum reimbursement is received for physician billing. The ideal candidate would have a strong understanding of medical claims billing. This individual will also be responsible for researching and resolving claims denials, monitor that all denied claims are corrected or appealed, and provide appropriate feedback to management. This employee will enter charges and submit them electronically or via paper to an insurance company or patient. They complete the cycle by up on outstanding charges.

RESPONSIBILITIES:

• Ensuring appropriate information is submitted to insurance companies to expedite payment
• Preform collection activities, including status check up calls to ensure timely reimbursements, appeals, and account reviews
• Take appropriate follow up actions on accounts to ensure claims are paid on the first follow-up call or appeal. 
• Following up on assigned cases from within the organization 
• Reviewing pre-bill claim holds to verify that the claim goes out clean the first time 
• Composing appeals to insurance carriers for denied claims, completing denials and rejection reports
• Work insurance aging reports
• Submit insurance and patient refunds as needed
• Educate staff on contracted and non-contracted plans, and which we can accept
• Post payments and charges
• Ability to navigate insurance, hospital, and other websites to verify benefits or research outstanding payments
• Handle incoming calls for information request from insurance companies within 24 hours
• Assisting Financial Counselors when patients have questions regarding claims 
• Corrects accounts that are billed to incorrect insurance companies. 
• Ensures authorizations are attached to claims 
• Comply with quantity and quality expectations as provided by management 
• Communicating with the DeLand Office Manager to advise of trends, issues discovered 
• All other duties as assigned. 

EDUCATION & EXPERIENCE:

• High School Diploma or general education degree (GED)
• 2 – 4 years of physician office billing and denial management experience required 
• Basic Understanding of ICD10, CPT HCPCS  
• Ability to read and interpret explanation of benefits (EOBs) 
• Knowledge of Medical Assistance, Medicare Part B and commercial insurance products  
• Familiar with CMS 1500 
• Basic understanding of medical terminology and anatomy.   
• Excellent communication skills both written and verbal 
• Must be a self-starter that is detail oriented and capable of multi-tasking 
• Requires comprehensive knowledge of computer skills including Microsoft Office Suite 
• Comfortable in a fast-paced working environment of a growing practice 

PREFFERRED QUALIFICATIONS & SKILLS

• Experience in a medical center, large health system, or multi‑specialty group
• Athena experience strongly preferred 

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.