Revenue Support Cycle Specialist - Remote

Job Description

Job Description

ESSENTIAL FUNCTIONS

• Provide float coverage across billing, insurance follow-up, claim creation, patient collections, and special projects assigned by management.

• Create claims following provider review of the billing tab, ensuring accuracy and completeness prior to submission.

• Work assigned claim rules and edits related to clinical claim creation.

• Ensure timely filing, follow-up, and collection of complex insurance claims, including workers’ compensation, commercial, managed care, federal, state, and other third-party payers.

•Review CPT and ICD-10 codes for accuracy using Medicare Guidelines, CCI, AAOS and other medical data/coding computer software, considering the different billing rules of medical insurance carriers. Enter conclusions, action taken, conversation detail, patient data, into the practice management system with great efficiency and accuracy.

• Review, research, and appeal denials and underpayments from insurance carriers and patients; apply appropriate discounts, charge adjustments, refunds, write-offs, and claim releases in accordance with policies and procedures.

• Enter clear, accurate documentation of actions taken, payer communications, and patient data into the practice management system. Work assigned claims, reports, work queues, and claim-creation tasks in a timely and efficient manner.

• Consult with physicians, non-physician practitioners, and revenue cycle staff to obtain missing information or correct billing and coding discrepancies. Assist staff members and patients in resolving insurance carrier or agency issues, including responding to patient billing inquiries and phone calls as needed.

• Identify trends and opportunities to reduce denials, improve claim quality at the front end, and enhance overall performance.

• Handle confidential patient and medical records in a professional, discreet, and compliant manner always.

• Follow all corporate, compliance, and revenue cycle policies and procedures.

• Perform additional duties and responsibilities as deemed appropriate to support operations.

GENERAL COMPENTENCIES DESIRED

• Self-motivated with the ability to work independently and adapt quickly to changing priorities.

•Strong knowledge of medical billing workflows, claim creation processes, and insurance guidelines.

•Familiarity with Medicare, Medicaid, HMO, PPO, workers’ compensation, and commercial payer guidelines.

•Understanding of insurance billing workflows and common payer reimbursement methodologies.

•Broad knowledge of payer contracts, fee schedules, multiple surgery discounts, and underpayment identification.

•High level of attention to detail with a strong commitment to accuracy and compliance.

•Effective oral and written communication skills, including clear documentation.

•Strong organizational, planning, and time-management skills.

•Excellent interpersonal and problem-solving skills.

•Comfort with learning and utilizing digital tools and workflows.

•Proficiency with Microsoft applications, practice management systems, and electronic health records.

•Ability to multitask, prioritize workload, and meet deadlines in a fast-paced environment.

PHYSICAL DEMANDS

This position requires prolonged periods of sitting and the ability to operate standard office equipment, including a computer, keyboard, telephone, calculator, scanner, and copier. Normal vision and hearing are required to prepare, review, and communicate information. The role may involve working under deadlines and handling fluctuating workloads.

CREDENTIALS DESIRED

High school diploma or equivalent required. Minimum of two (2) years of prior experience in a medical business office with emphasis on coding, billing, and insurance follow-up required. Orthopedic billing and insurance experience preferred.

HOURS:  Monday - Friday

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.