Billing Specialist, Value-Based Services

Overview At OrthoCarolina, our team is our greatest asset and the foundation of our success. We are a diverse group of individuals accountable to each other to uphold the standards of excellence and promote an environment of teamwork throughout the organization. OrthoCarolina has 43 unique care locations with over 1300 professionals who share a common goal to make lives better. We are currently searching for a Billing Specialist to work with our Value Based Services team. The Value-Based Services (VBS) Billing Specialist is a specialized role dedicated to supporting Value-Based Services operations. This position is responsible for tracking value-based episodes of care and managing all aspects of billing and posting for assigned cases. Essential Functions Maintain a comprehensive understanding of all Value-Based contracts, payment models, and reconciliation requirements at OrthoCarolina. Serve as the primary billing expert and resource for Value-Based Services across all locations. Manage all aspects of the billing lifecycle for Value-Based episodes of care, from episode creation through final reconciliation and closeout. Enter and submit all required claims (e.g., facility, anesthesia, physical therapy) for bundled episodes in EPIC and affiliated practice management systems, ensuring all front-end edits and validations are in place. Act as the primary liaison with third‑party billing partners to ensure accurate episode creation, claims submission, and timely transfer of funds into EPIC. Ensure all claims are received and processed appropriately to successfully close each episode of care. Collaborate with payers on reconciliation processes in accordance with contract terms (e.g., monthly or quarterly). Assist with monthly reporting, quarterly reconciliation, and year‑end close activities as directed by leadership. Serve as a liaison between patients, payers, providers, and facilities to resolve billing and payment concerns. Handle patient inquiries related to financial accounts professionally and work directly with patients to resolve balances. Attend meetings, huddles, and program‑related calls to stay informed of Value-Based Services updates and changes. Skills and Abilities Ability to work with numbers, perform simple math functions, and understand insurance payments and recoupments. Proficient in Excel and spreadsheets. Knowledge of medical payment data entry and computerized medical software. Knowledge of medical, insurance and EOB terminology. Qualifications High school GED required; Associate degree in business, Medical Office Administration, or related field preferred. Some college or accounting experience required. Minimum two years in a health care business office setting. Experience with insurance, benefits, prior authorization and patient collections preferred. Benefits Employees are eligible for a full spectrum of benefits including paid company holidays, wellness programs, and tuition reimbursement. #J-18808-Ljbffr