Orthopaedic Medical Billing Specialist

Orthopaedic Medical Billing Specialist

Children's Orthopaedic and Scoliosis Surgery Associates, LLP

Are you a detail‑oriented insurance collector passionate about ensuring accurate billing in a fast‑paced environment? We are seeking a highly motivated Billing Specialist to join our revenue cycle management team and play a vital role in bringing patient accounts to a zero balance.

In this role, you will oversee the billing process for healthcare services, ensuring accurate claim submissions and full payment collection. Your responsibilities will include reviewing rejected claims, making justified adjustments, handling appeals for denied or under‑paid claims, creating monthly Accounts Receivable reports, and resolving issues with provider representatives.

• Independently:
  • Analyze claim denials and take corrective action, including corrected claims, reconsiderations, and appeals.
  • Apply accurate adjustments based on insurance guidelines and contracts.
  • Manage secondary insurance and patient responsibility.
• Collaboratively:
  • Work closely with the team to resolve outstanding insurance payments. This includes pulling insurance policies and setting up system edits and scrubs to prevent future denials.
  • Correspond with Insurance Verification and Front Desk to input missing data and correct registration errors.
  • Communicate effectively with patients and front desk regarding balances and collect payments.

• Claims Management:
  Analyze and resolve rejected claims, ensuring accurate coding and modifiers per COSSA and payer policies.
• Appeals Process:
  Research, prepare, and submit appeals for denied or under‑paid claims. Draft detailed justification letters supported by documentation and payer policies.
• Collaboration:
  
  Coordinate with charge entry personnel and revenue cycle specialists to ensure accurate claim processing and resubmission. Work with providers to optimize appeals and validate adjustments.

• KPIs:
  Maintain an average Days in A/R of 35 or less, resolve credit balances monthly, manage claims effectively, review rejected claims within 5 days, and address preventable denials with appropriate edit scrubs.
• Metrics:
  Ensure high accuracy in claims processing, timely resolution of claims, and prompt responses to inquiries.
• Behaviors:
  Exhibit thoroughness, proactive communication, and teamwork. Assist colleagues and contribute to the team as a whole.
• Timelines and Responsiveness:
  Adhere to deadlines and respond quickly to queries.
• Quality:
  Maintain high standards of work with accurate, complete, and timely processing, aiming for zero adjustments due to past timely filing.
• Feedback:
  Receive positive feedback from staff and patients for professionalism and problem‑solving.

On‑site (St. Petersburg or Tampa Office Location)

Join a high‑functioning team that values collaboration, communication, flexibility, and a positive attitude. We seek individuals who contribute positively to team dynamics and foster a supportive work environment.

• Patient‑Focused Care:
  Prioritizing patient needs and well‑being.
• Competence:
  Maintaining high standards and pursuing certification within 2 years.
• Credibility:
  Acting with integrity and honesty.
• Innovation:
  Embracing new ideas to enhance workflows.
• Employee Recognition:
  Valuing individual contributions.

We are committed to the continuous development of our team members by offering opportunities for professional growth, ongoing learning, and skill enhancement through regular feedback, mentorship, and targeted training.

New hires are required to complete a 90‑day training period to familiarize themselves with our processes and integrate with the team.

Standard department hours are from 8:30 AM to 5:00 PM.

• Salary:
  Starting at $21 per hour, negotiable based on experience and certifications.
• Health Benefits:
  
  100% employee premium coverage for Medical (UHC), Dental (Delta) and a $20,000 life insurance policy with no payroll deductions. Coverage starts the first day of the month after your 30‑day anniversary.
• Pai…