Job Description

Under the direct supervision of the Revenue Cycle Supervisor, this position is responsible for ensuring the timely collection of accounts receivable, monitoring account activity, and providing appropriate follow-up to maximize reimbursement for physician billing. The ideal candidate will have a strong understanding of medical claims billing, denial management, and insurance follow-up in a fast-paced healthcare environment.

Key Responsibilities

• Perform collection activities, including status calls, appeals, and account reviews to ensure timely reimbursement.
• Research and resolve claims denials using appropriate internal and external resources.
• Monitor denied claims to ensure corrections or appeals are completed promptly.
• Review pre-bill claim holds to ensure claims are submitted cleanly the first time.
• Ensure appropriate and accurate information is submitted to insurance companies to expedite payment.
• Take proactive follow-up actions to secure payment on the first follow-up call or appeal whenever possible.
• Compose and submit appeals to insurance carriers for denied claims.
• Correct claims billed to incorrect insurance carriers and ensure authorizations are attached to claims.
• Handle incoming requests for information from insurance companies within 24 hours.
• Assist Financial Counselors with patient inquiries related to insurance claims.
• Collaborate with internal teams within the business office to resolve billing and reimbursement issues.
• Communicate trends, issues, and findings to the lead, supervisor, and management team.
• Comply with productivity, quality, and performance expectations established by management.
• Ensure compliance with all company plans, policies, and procedures set forth by Orthopaedic Solutions Management.
• Perform all other duties as assigned.

Education and Experience

• High School Diploma or General Education Degree (GED) required.
• 2–4 years of physician office billing and denial management experience required.
• Working knowledge of ICD-10, CPT, and HCPCS coding.
• Ability to read and interpret Explanation of Benefits (EOBs).
• Knowledge of Medicare Part B, Medical Assistance, and commercial insurance products.
• Familiarity with CMS-1500 claim forms.
• Basic understanding of medical terminology and anatomy.

Preferred Qualifications and Skills

• Athena billing system experience strongly preferred.
• Excellent written and verbal communication skills.
• Strong attention to detail with the ability to multitask and work independently.
• Proficient in Microsoft Office Suite and general computer applications.
• Ability to work effectively in a fast-paced, growing practice environment.
• Self-starter with strong organizational and problem-solving skills.

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.