Job Description

Key Responsibilities:

• Works all payments and applies monies correctly on a daily basis.
• Resolves credit accounts through refunds, adjustments, transfers, etc.
• Contacts payers by any means possible to determine coordination of benefits, contractual adjustments, and patient responsibility as necessary to resolve the credit balance correctly.
• Researches EOB’s related to refund requests, off pays, recoupments, and forward balances.
• Applies federal and state prompt payment language as appropriate to invalidate insurance refund requests.
• Notifies management of any trends identified in workflows that may be creating the credit balances.
• Ensures all validated Government payer requests are processed within payer guidelines.
• Maintains daily, weekly, and monthly quantitative and qualitative production standards.
• Coordinates work assignments with peers to ensure that all departmental responsibilities are being completed as expected.
• Communicates effectively with other areas within OSM and its affiliates to facilitate fulfillment of information requests.
• Communicates effectively with management to obtain issue resolution and determining work priority.
• Address all emails from Business Office, leadership and assigned cases within 48 hours.
• Identifies underpayments and recovery opportunities – communicates findings to leadership.
• Performs duties in compliance with Medicare, federal, state, contractual agreements, and internal policies of OSM.

Qualifications:

1. Minimum of 3-5 years of experience as a medical reimbursement specialist, healthcare insurance collector, patient account representative, medical collector, or a similar position in medical/physician practice. Must have strong experience with collecting money from insurance companies. Experience as a payment poster is preferred but not required.

2. Minimum of 3-5 years of experience with resolving credit balances, performing account reconciliation, identifying variances, processing refunds, and identifying trends.

3. Strong understanding of medical terminology, procedure and diagnosis codes, insurance terms, payer reimbursement methodology & contract language including but not limited to Medicare, Medicaid, Workers Compensation, Managed Care, exclusions, case rates, % of charges and fee schedules. Experience with orthopedics is highly desired but not required.

4. Proficiency in interpreting explanation of benefits (EOB) with the ability to trace the flow of payer offsets, recoupments, and forward balances.

5. Basic ability in Microsoft Excel is required.

6. Knowledge of basic accounting and mathematics principles. Must be able to calculate reimbursements and refund amounts.

7. Strong ability to prioritize work assignments, work independently or coordinate with team members, multi-task, can adapt well to change, has a keen attention to detail, and is highly accurate.

8. High School diploma or equivalent. College preferred.

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.