Health Claims Collections Specialist II

Location: Northern

## Health Claims Collections Specialist IIApply:
Remote - United States:
Full time:
Posted Yesterday:
OFX
26381
** Why Orthofix?
** Guided by our organizational values –
** Take Ownership** |
** Innovate Boldly** |
** Win Together** – we collaborate closely with world-class surgeons and other partners to improve people’s quality of life. At Orthofix, we want team members who build relationships and share knowledge, challenge the status quo, and deliver results every day to help us achieve our vision to be the
*** unrivaled
* ** partner in Med Tech.  Our global team of over 1,600 employees brings to market highly innovative, cost-effective, and user-friendly medical technologies that heal musculoskeletal pathologies for patients and the healthcare professionals who treat them. Looking to change people’s lives? Look no further.
** JOB PURPOSE
** The Specialist II, Health Claims Collections is responsible for resolving complex post-payment and denied DME claims.  Operating within a wing-to-wing revenue cycle management team, this role takes ownership of highly escalated accounts, advanced appeals, payer trend analysis, and cross-functional issue resolution.  The Specialist II, Health Claims Collections serves as a subject matter resource of junior collectors and assists leadership in driving payer compliance and revenue recovery.

** ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
*** The following are the essential functions of this position. This position may be responsible for performing additional duties and tasks as needed and assigned.
** Independently manage a portfolio of high-priority and complex claims requiring advanced solutions and strategies.
* Analyze denials, over payments and underpayments to determine root cause; execute appropriate action plans including appeals, escalations and payer outreach.
* Submit technical, clinical and medical necessity appeals at all levels (including external reviews) with supporting documentation.
* Research payer contract language, LCD/NCD guidelines and policy updates; apply findings to claims resolution and communicate relevant changes to peers and leadership.
* Identify payer trends (example, systemic rejections, denials, over payments or underpayments) and escalate issues with supporting data to payer contacts and leadership.
* Resolve escalated issues involving prepay audits, refund requests, rebills, recoupments and coordination of benefits discrepancies.
* Manage HCFA returns and claim corrections, ensuring clean resubmission per billing guidelines.
* Communicate effectively with leadership and cross-functional teams to resolve multifaceted claim barriers.
* Ensure account documentation is accurate, detailed, and audit ready across all internal system.
* Consistently meet or exceed departmental metrics related to productivity, quality, aging resolution, and cash recovery.  
** MINIMUM QUALIFICATIONS
*** The requirements listed below are representative of the education, knowledge, skill and/or ability required for this position.
* ** Education/

Certifications:

*** High School Diploma or Equivalent Experience  
** Experience, Skills, Knowledge and/or Abilities:
*** Minimum 2+ years of medical collection or revenue cycle experience with emphasis on post-billing DME or orthopedic claims.
* Advanced knowledge of payer guidelines, revenue cycle management, and appeals processes (Medicare, Medicare advantage, Medicaid, and commercial insurance payers).
* Proficiency in reading and interpreting EOBs, payer policies, LCDs, and prior authorization requirements.
* Strong working knowledge of ICD-10, HCPCs and billing procedures for CMS-1500 claim forms.
* Proficient in Microsoft Office and medical billing platforms.
* Demonstrated experience with complex denials, payer escalations,…