Orthopaedic Medical Billing Specialist

Join Our Thriving Pediatric Orthopaedic Group!

Are you a detail-oriented insurance collector passionate about ensuring accurate billing in a fast-paced environment? We are seeking a highly motivated Billing Specialist to join our revenue cycle management team and play a vital role in bringing patient accounts to a zero balance.

Role Overview: In this role, you will oversee the billing process for healthcare services, ensuring accurate claim submissions and full payment collection. Your responsibilities will include reviewing rejected claims, making justified adjustments, handling appeals for denied or underpaid claims, creating monthly Accounts Receivable reports, and resolving issues with provider representatives.

What You'll Do:

• Independently:

  • Analyze claim denials and take corrective action, including corrected claims, reconsiderations, and appeals.
  • Apply accurate adjustments based on insurance guidelines and contracts.
  • Manage secondary insurance and patient responsibility.

• Collaboratively:

  • Work closely with the team to resolve outstanding insurance payments. This includes pulling insurance policies and setting up system edits and scrubs to prevent future denials.
  • Correspond with Insurance Verification and Front Desk to input missing data and correct registration errors.
  • Communicate effectively with patients and front desk regarding balances and collect payments.

Daily Responsibilities:

• Claims Management: Analyze and resolve rejected claims, ensuring accurate coding and modifiers per COSSA and payer policies.
• Appeals Process: Research, prepare, and submit appeals for denied or underpaid claims. Draft detailed justification letters supported by documentation and payer policies.
• Collaboration: Coordinate with charge entry personnel and revenue cycle specialists to ensure accurate claim processing and resubmission. Work with providers to optimize appeals and validate adjustments.

Success Factors: Success in this role is defined by:

• KPIs: Maintain an average Days in A/R of 35 or less, resolve credit balances monthly, manage claims effectively, review rejected claims within 5 days, and address preventable denials with appropriate edit scrubs.
• Metrics: Ensure high accuracy in claims processing, timely resolution of claims, and prompt responses to inquiries.
• Behaviors: Exhibit thoroughness, proactive communication, and teamwork. Assist colleagues and contribute to the team as a whole.
• Timelines and Responsiveness: Adhere to deadlines and respond quickly to queries.
• Quality: Maintain high standards of work with accurate, complete, and timely processing, aiming for zero adjustments due to past timely filing.
• Feedback: Receive positive feedback from staff and patients for professionalism and problem-solving.

Work Environment: We offer a flexible work arrangement – remote, hybrid, or on-premise. Employees must reside in Florida within an hour of Tampa Bay for on-site training and meetings. We encourage a hybrid work setup where employees work in the office a few days a week and remotely on other days. Exceptional candidates living more than 30 minutes from the office may be considered for fully remote work, with responsibilities including attending key in-person meetings and covering vacations as needed.

Team Dynamics: Join a high-functioning team that values collaboration, communication, flexibility, and a positive attitude. We seek individuals who contribute positively to team dynamics and foster a supportive work environment.

Cultural Fit and Team Development: We value:

• Patient-Focused Care: Prioritizing patient needs and well-being.
• Competence: Maintaining high standards and pursuing certification within 2 years.
• Credibility: Acting with integrity and honesty.
• Innovation: Embracing new ideas to enhance workflows.
• Employee Recognition: Valuing individual contributions.

We are committed to the continuous development of our team members by offering opportunities for professional growth, ongoing learning, and skill enhancement through regular feedback, mentorship, and targeted training.

Training Period: New hires are required to complete a 90-day in-office training period to familiarize themselves with our processes and integrate with the team.

Work Hours: Standard department hours are from 8:30 AM to 5:00 PM. Flexible scheduling is available, with some employees starting between 7:00 AM and 10:00 AM to ensure coverage and timely patient care.

Salary and Benefits:

• Salary: Starting at $21 per hour, negotiable based on experience and certifications.
• Health Benefits: 100% employee premium coverage for Medical (UHC), Dental (Delta), and a $20,000 life insurance policy with no payroll deductions. Coverage starts the first day of the month after your 30-day anniversary.
• Paid Time Off: 16 days of PTO and 5 days of SD/Serious Illness accrued in the first year.
• Profit Sharing: Contributions begin after one year, with a historical rate of at least 14% annually. No payroll deductions for retirement savings, with vesting up to 20% annually over five years.

Qualifications:

• Minimum of 2 years’ experience as a medical billing specialist.
• Proven track record in AR follow-up, EDI management, coding, medical terminology, and computer skills.
• CPC or CPB certification (or willingness to obtain within 2 years).
• Experience in insurance verification and pediatrics/orthopaedics is a plus. Familiarity with AthenaPractice, Encoda, or Phreesia is preferred. Knowledge of Florida Medicaid billing is a bonus.

Ready to grow your career with a dynamic team? Apply today!