Job Description

Healthcare Outcomes Performance Company (HOPCo) is a physician managed company focused on transforming the patient care experience and improving the practice of medicine. We are experts in orthopedic medicine. Thus, we uniquely manage orthopedic practices and hospital service lines across the country to enhance the healthcare experience for patients and physicians.

As HOPCo continues to grow, we are looking for a Site Billing Specialist Please see below for the functions and requirements for this position.

ESSENTIAL FUNCTIONS

• Maintains productivity and accuracy metrics per department expectation and AEIOU Behavioral Standards.
• Abstracts data from medical records to ensure proper coding of diagnosis and procedures including any applicable modifiers.
• Reviews insurance denials and rejections to determine next appropriate action steps and obtain necessary information to resolve any outstanding denials/rejections.
• Updates and confirms as necessary to allow processing of claims to insurance plans.
• Researches all information needed to complete billing process including obtaining information from providers, ancillary services staff and patients.
• Attaches referrals/authorizations to appointments/charges if available.
• Maintains satisfactory productivity rates and ensures the timeliness of claims reimbursement while maintaining work queue goals.
• Makes and receives calls to/from patients to collect on self-pay balances and any other outstanding balance.
• Councils patients face to face when patients have questions or concerns regarding outstanding balances.
• Acts as a resource to staff and providers including providing subject matter expert education on billing and coding guidelines.
• Completes daily requests and working through obstacles on account balance to ensure maximum reimbursement.
• Identifies and communicates trends and/or potential issues to management team.
• Follows and maintains all CORE Institute policies and procedures, including those specific to billing and the Business Office.
• Other duties as assigned by leadership.

EDUCATION

• High school diploma/GED or equivalent working knowledge preferred.

EXPERIENCE

• Minimum two to three years of billing experience in a physician practice.
• Must be able to communicate effectively with physicians, patients and the public and be capable of establishing good working relationships with both internal and external customers.
• Prefer prior coding experience with CPC, CCS, RHIT or RHIA Certification.

KNOWLEDGE

• Minimum two to three years of billing experience in a physician practice. Must be able to communicate effectively with physicians, patients and the public and be capable of establishing good working relationships with both internal and external customers. Prefer prior coding experience with CPC, CCS, RHIT or RHIA Certification.
• Knowledge of government provisions and billing guidelines.
• Advanced computer knowledge, including Window based programs.

SKILLS

• Skilled in defusing difficult situations and able to be consistently pleasant and helpful.
• Skill in using computer programs and applications.
• Skill in establishing good working relationships with both internal and external customers.

ABILITIES

• Ability to multi task in a fast paced environment. Must be detailed oriented with strong organizational skills.
• Ability to understand patient demographic information and determine insurance eligibility.
• Ability to work independently and demonstrate the ability to analyze data.
• Ability to type a minimum of 45 wpm.

ENVIRONMENTAL WORKING CONDITIONS

• Normal office environment.

PHYSICAL/MENTAL DEMANDS

• Requires sitting and standing associated with a normal office environment.
• Combination of bending, lifting and transferring activities.
• Manual dexterity using a calculator and computer keyboard.

ORGANIZATIONAL REQUIREMENTS

• HOPCo Mission, Vision and Values must be read and signed.

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