RCM Specialist: Orthopedics

We are seeking a detail-oriented and experienced RCM Specialist with a strong understanding of orthopedic billing and coding to deliver exceptional service to our clients. Candidates without prior orthopedic billing experience will not be considered. This role is responsible for managing the full revenue cycle for assigned orthopedic practices, ensuring optimal reimbursement and client satisfaction.

Key Responsibilities:

• Oversee all aspects of the orthopedic revenue cycle, including credentialing support, claim submission, payment posting, AR follow-up, denial management, and identifying payer trends specific to orthopedics.
• Serve as the primary point of contact and liaison between orthopedic clients and the remote billing/coding team.
• Build and maintain strong client relationships, ensuring consistent and proactive communication via phone, email, and video calls.
• Monitor and analyze key orthopedic revenue cycle KPIs, providing regular reports and insights to clients on financial performance and AR variances.
• Collaborate with the remote billing/coding team to resolve billing issues, payment discrepancies, and denials related to orthopedic procedures and diagnoses.
• Research payer policies and guidelines relevant to orthopedic billing to ensure accurate claim submissions and maximize reimbursement.
• Manage client onboarding for new orthopedic accounts, coordinating with internal teams.
• Recommend and implement process improvements based on client needs and orthopedic billing best practices.
• Maintain strict confidentiality in compliance with HIPAA regulations.

Job Requirements:

• High School Diploma.
• Minimum 3 years of experience in medical billing with a required focus on orthopedics.
• Thorough knowledge of ICD-10 and CPT coding specific to orthopedic procedures, including modifiers, NCCI edits, and relevant payer guidelines.
• Proven understanding of orthopedic insurance reimbursement practices and the overall revenue cycle.
• Excellent client service and communication skills (written and verbal).
• Strong computer skills, including proficiency in Excel.
• Ability to effectively collaborate with clients and internal teams.
• Strong organizational, problem-solving, and analytical skills.
• Self-motivated with the ability to work independently and manage multiple tasks.
• Familiarity with Modernizing Medicine (ModMed) or eClinicalWorks is a bonus.
• Commitment to maintaining confidentiality and adhering to HIPAA regulations