Revenue Cycle Specialist

Position Summary:


Under direct supervision of the Worker's Comp Manager, this position is responsible for assuring timely collection of accounts receivable, 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.

• Research and resolve claims denials using the appropriate resources
• Check that pre-bill claims are passing internal edits in a timely fashion
• Monitor that all denied claims are corrected or appealed
• Collaborate with other teams within the business office
• Provide appropriate feedback to management.

Key Responsibilities:

• Performing collection activities, such as status calls to ensure timely reimbursement, appeals and account review.
• Ensuring appropriate information is submitted to insurance companies in order to expedite payment.
• Take appropriate follow up actions on accounts to ensure claims are paid on the first follow-up call or appeal.
• Determine that appropriate information is submitted to insurance companies in order to expedite payment
• 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
• 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 lead, supervisor and team to advise of trends, issues discovered
• Assure compliance with all company plans, policies and procedures set forth by the Florida Orthopaedic Institute
• All other duties as assigned.

Qualifications:

• 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)
• 4+ years of experience with worker's compensation and commercial insurance products
• Familiar with CMS 1500
• Basic understanding of medical terminology and anatomy
• Athena experience strongly preferred
• 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

At FOI our goal is to provide our patients with world-class orthopedic care.

Our mission of providing the best care encompasses not only the care the physician provides, but all medical and administrative aspects of the patients encounter with Florida Orthopaedic Institute (FOI) as well. Every staff member plays a vital role in this mission. We take pride in receiving the Patriot Award from the Department of Defense for the support that we give to National Guard and Reserve members who are employed by FOI. We are committed to encouraging a culture of inclusion reflective of the communities we serve, and we provide equal opportunity to all. Florida Orthopaedic Institute conforms to the spirit as well as to the letter of all applicable laws and regulations.


What we offer:

• Full time opportunities available, with room for career growth and advancement.

• Excellent job security and stability, to promote an optimal work life balance.

• Be part of this dynamic and growing high level 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.