Denial Management Specialist – Orthopedic Services

This is a fully remote position, open to applicants in Florida.

📋 Description

• Assist in managing orthopedic revenue cycle and denial management operations

• Comprehend the complete revenue cycle, which includes coding, claim submission, payer follow-up, denial resolution, and appeals

• Initially concentrate on orthopedic denials and ERISA appeals

• Provide support for billing, coding, accounts receivable, claims follow-up, and denial management across various specialties

⛳️ Requirements

• CPC, CCS, CPMA, or similar certification is preferred, though not mandatory

• CPB certification is preferred

• At least three years of professional experience in healthcare revenue cycle management

• Required professional experience in both medical billing and medical coding

• Experience in denial management, claims resolution, accounts receivable follow-up, appeals, or payer correspondence

• Familiarity with Epic, Athena, NextGen, eClinicalWorks, or similar healthcare systems

• Knowledge of CPT, HCPCS, ICD-10-CM, modifiers, NCCI edits, medical necessity requirements, and payer reimbursement guidelines

• Experience working with commercial insurance, Medicare, Medicaid, self-funded health plans, payer portals, and claim follow-up processes

• Capability to review medical records, claims, EOBs, remittance advice, and payer correspondence to identify billing and coding discrepancies

• Excellent written communication skills with experience in drafting professional appeal letters

• Strong analytical, organizational, and problem-solving skills

• Ability to manage a high-volume workload independently and meet payer deadlines

• Proficiency in Microsoft Excel, Word, and Outlook.

🏝️ Benefits

• Comprehensive benefits package

• Supportive leadership environment

• Opportunities for professional advancement

• Stable, long-term employment