Billing Specialist, Value-Based Services

About the role

The Value-Based Services (VBS) Billing Specialist plays a critical role in supporting the financial operations of OrthoCarolina's Value-Based Services team. This position is essential for maintaining accurate billing and post-care processes, ensuring timely payment and efficient reconciliation.

Responsibilities

• Maintain a comprehensive understanding of all Value-Based contracts, payment models, and reconciliation requirements.
• Manage all aspects of the billing lifecycle for Value-Based episodes of care, from episode creation through final reconciliation and closeout.
• Enter and submit all required claims (e.g., facility, anesthesia, physical therapy) for bundled episodes in EPIC and affiliated practice management systems, ensuring all front-end edits and validations are in place.
• Act as the primary liaison with third-party billing partners to ensure accurate episode creation, claims submission, and timely transfer of funds into EPIC.
• Ensure all claims are received and processed appropriately to successfully close each episode of care.
• Collaborate with payers on reconciliation processes in accordance with contract terms (e.g., monthly or quarterly).
• Absorb and resolve account-level issues, initiate corrective actions, and resolve barriers efficiently to ensure smooth financial transactions for an assigned patient population.
• Assist with monthly reporting, quarterly reconciliation, and year-end close activities as directed by leadership.
• Serve as a liaison between patients, payers, providers, and facilities to resolve billing and payment concerns.
• Handle patient inquiries related to financial accounts professionally and work directly with patients to resolve balances.
• Attend meetings, huddles, and program-related calls to stay informed of Value-Based Services updates and changes.

Qualifications

• High School GED or equivalent.
• Associate degree in business, Medical Office Administration, or other related fields preferred.
• Some college or accounting required.
• Minimum two years in a health care business office setting.
• Experience with insurance, benefits, prior authorization, and patient collections preferred.

Skills

• Able to work with numbers, simple math functions, and understand insurance payments and recoupments.
• Proficient in Excel/spreadsheets.
• Knowledge of medical payment data entry.
• Knowledge of computerized medical software.
• Knowledge of medical, insurance, and insurance EOB terminology.