Revenue Cycle Specialist

Job Summary

Job Details

Compensation: Starting at $18 an hour
Travel Requirements: Orientation: Must be able to attend orientation in the Tampa Bay Area
Quarterly Meetings: Must be able to travel to the Tampa Bay area for quarterly meetings

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 accurately and timely.
• Review pre-bill claim holds and internal edits to ensure claims are submitted cleanly and timely.
• Ensure appropriate and complete 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 when possible.
• Follow up on assigned cases and work queues within the organization.
• Compose and submit appeals to insurance carriers for denied claims.
• Handle incoming requests for information from insurance companies within 24 hours.
• Aid Financial Counselors with patient inquiries related to claims.
• Correct accounts billed to incorrect insurance carriers.
• Ensure required authorizations are attached to claims prior to submission.
• Meet quantity and quality performance expectations as established by management.
• Communicate trends, issues, and findings to the lead, supervisor, and team.
• Collaborate with other teams within the business office to resolve billing and reimbursement issues.
• Provide appropriate feedback to management regarding process improvements and challenges.
• Ensure compliance with all company plans, policies, and procedures set forth by Orthopaedic Solutions Management.

Education And Experience

• High School Diploma or GED required.
• Minimum of 2–4 years of medical billing, collections, or denial management experience preferred.
• Experience with ancillary billing strongly preferred.

Preferred Qualifications & Skills

• Strong knowledge of medical claims billing and reimbursement processes.
• Ability to read and interpret Explanation of Benefits (EOBs).
• Excellent written and verbal communication skills.
• Strong attention to detail and organizational skills.
• Ability to manage multiple priorities in a fast-paced environment.
• Proficient in basic computer applications and billing systems.
• Ability to work independently and collaboratively as part of a team.