Medical Billing and Collections Specialist

Medical Billing and Collections Specialist

Join to apply for the Medical Billing and Collections Specialist role at Orthopedic Specialists of Northwest Indiana.

• Knows, understands, incorporates, and demonstrates the OSNI Core Mission, Vision, and Values in behaviors, practices, and decisions.
• Performs all follow‑up functions, including investigation of underpayments, payment delays resulting from denied, rejected, and/or pending claims, with the objective of appropriately maximizing reimbursement based upon services delivered and ensuring that the claim is paid/settled in the most timely manner.
• Utilizes available data and resources to make decisions regarding complexity of claim processing and payment propensity, and the appropriateness of transferring account to the Billing Manager.
• Researches claim rejections, makes corrections, takes corrective actions and/or refers claims to appropriate staff members for follow‑through to ensure timely claim resolutions.
• Proactively follows up on delayed payments by contacting patients and 3rd‑party payers, and supplying additional data, as required.
• May perform financial counseling activities, including but not limited to: discussing balances with patients, setting up payment plans, explaining statements and insurance processing.
• Counsels patient/guarantor on patient financial liability, third‑party payer requirements, and payment plan options.
• Investigates No‑Fault and Workers' Compensation cases, retrieving police reports and insurance information, as required.
• Determines and manages proper course of action for optimal reimbursement of healthcare charges.
• Evaluates accounts, resubmits claims, and performs refunds, adjustments, write‑offs and/or balance reversals if charges were improperly billed or payments were incorrect.
• Updates and refiles claim forms in a timely, accurate manner.
• Responds to patient and 3rd‑party payer inquiries (telephone, fax, mail, and web‑based patient portal), complaints or issues regarding patient billing and collections, either responding directly or referring the problem to an appropriate resource for resolution.
• Communicates with physicians and their office staff, Patient Access, Medical Records/Health Information Management, Utilization Review/Case Management, Managed Care, Ancillary and Nursing staff as required to clarify billing discrepancies and obtain demographic, clinical, financial and insurance information.
• May prepare special reports as directed by the Manager to document billing and follow‑up services (e.g., number of claims and dollars billed, number of claims edited, number of claims unprocessed, etc.).
• May serve as relief support if the work schedule or workload demands assistance to departmental personnel.
• May also be chosen to serve as a resource to train new employees.
• Cross‑training in various functions is expected to assist in the smooth delivery of departmental services.
• Maintains a working knowledge of applicable Federal, State, and local laws and regulations, as well as OSNI’s Standards of Conduct, and other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.
• Other duties as needed and assigned by Billing Manager, Practice Manager, and/or CEO.

• High school diploma or an equivalent combination of education and experience.
• Associate degree or higher in coding or health information management, accounting or business administration highly desired.
• Past work experience of at least one year within a healthcare setting, an insurance company, managed care organization or other financial service setting, performing medical claims processing, patient financial counseling, coding and/or claims follow‑up is required.
• Knowledge of insurance and governmental programs, regulations and billing processes (e.g., CMS, Anthem, UHC, etc.), managed care contracts and coordination of benefits is required.
• Working knowledge of medical terminology, anatomy and physiology, medical record coding (ICD‑10, CPT, HCPCS), and basic computer skills are required.
• Excellent communication (verbal and writing) and organizational abilities. Interpersonal skills…