Revenue Cycle Specialist – Orthopedic Care

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

📋 Description

• Monitor, assess, and contest payer claim denials using systematic denial management processes.

• Evaluate payer contract effectiveness and fee structures to identify instances of underpayment.

• Calculate and secure upfront patient financial obligations utilizing real-time eligibility verification tools.

• Reconcile underpayments with payer contract fee structures and review high-reimbursement scenarios.

• Ensure that reimbursements comply with beneficiary requirements, medical necessity standards, practitioner scope, and coding guidelines.

• Identify the underlying causes of billing discrepancies, implement preventative measures, retrain on coding methods, and review related policies and procedures.

• Issue timely refunds for overpayments to payors, adhering to federal or state healthcare program regulations.

• Improve knowledge of compliance coding and billing through ongoing training initiatives.

• Engage in coding reviews and oversee adherence to coding practices.

• Participate in internal audits and resolve discrepancies through corrective measures.

• Stay informed about updates in coding, reimbursement, and regulatory frameworks.

• Ensure that collections and accounts receivable processes adhere to regulations, safeguard patient information, and uphold financial integrity.

• Maintain and implement a billing and receivables system that guarantees compliance, accurate reimbursement, patient confidentiality, and streamlined cash flow.

⛳️ Requirements

• Preferred degree, certificate, or diploma in medical billing, health information management, or healthcare administration.

• Completion of a medical billing training program is preferred.

• Certification as a Professional Biller (CPB) is a significant advantage.

• Outstanding communication skills for effective interaction with patients, healthcare providers, and insurance companies.

• Impeccable attention to detail to ensure claims are processed accurately and promptly, and that payments are secured.

• Capability to handle multiple responsibilities and prioritize tasks efficiently.

• Proficient in using various digital tools for billing, record keeping, and patient care directives.

• Authorized to work in the US for any employer without the need for sponsorship.

🏝️ Benefits

• Competitive salary and comprehensive benefits package.

• Opportunities for professional development and career advancement.

• Supportive work environment with a focus on teamwork and collaboration.

• Access to training and certification programs to enhance skills.

• Flexible work arrangements to promote work-life balance.