Medical Billing Representative - Orthopedic One

• POSITION SUMMARY
  • Responsible for the expedient collection of payment at the highest level of reimbursement allowed for the medical services provided for assigned physicians.
• RESPONSIBILITIES AND ACCOUNTABILITIES
  • Claims:
    • Reviews outstanding claims and follows up with insurance carriers regarding denials for specified physicians reviewing aged report monthly.
    • Claims that remain unpaid should be followed up on no later than 60 days past submission
    • Accurately records account receivable note of actions taken on each claim.
  • Reimbursement:
    • Professionally communicates with physicians and their staff regarding reimbursement problems when necessary.
    • Audits charges for optimal charge coding when needed. Communicates carrier claims denial patterns to Supervisor.
    • Keeps up on changes in medical billing and coding procedures. Follows insurance carrier guidelines. Communicates carrier updates to Supervisor.
  • Collections:
    • Follows department collection guidelines and procedures for outstanding patient and insurance balances related to assigned carriers and/or providers.
  • Denials:
    • Submits corrected claims and appeals to insurance carriers timely. Accessing carrier websites when applicable.
    • Responds to all types of correspondence within one week of receipt.
    • Accurately records account receivable note of actions taken on claims denials.
  • Customer Service and Communications:
    • Communicates with patients, insurance carriers and other outside entities in a professional manner. Identifies solutions and responds professionally to patient concerns, i.e., pleasant tone of voice, courteous language, etc. Uses appropriate grammar and demonstrates tact and diplomacy in patient interactions, by phone and in person.
    • Diffuses negative situations with patients and maintains a pleasant and professional tone during stressful circumstances and heavy workload.
    • Communicates with staff members in a professional, pleasant manner; Shares information relevant to work, no gossiping or disparaging remarks, accepts work without complaint or provides reasons why assignment is unmanageable, asks and answers questions related to improving department performance
• TEAMWORK
  • Teamwork:
    • Willingly provides coverage, volunteers assistance, and maintains workflows within department as needed without direct instruction/supervision.
    • Works cooperatively and refrains from participating in negative conversations.
    • Shares knowledge and insights with co-workers in a constructive manner.
    • Works to solve problems and address conflicts with appropriate person directly before involving leadership or uninvolved peers.
    • Is considerate of others in the work environment with regard to taking breaks or meal periods, use of computer and phone, noise level in the department, etc.
• POLICIES AND PROCEDURES
  • Policies and Procedures
    • Knows and complies with policies and procedures as enumerated in the Orthopedic One Employee Handbook and policies and procedures documents.
    • Provides assistance and support to leadership in implementing policies and procedures as necessary.
    • Actively participates in training, and conducting day to day work activity by adhering to all policies and procedures as enumerated in compliance and risk management programs.
• QUALIFICATIONS
  • Education, Experience, Certification and Licensure Requirements:
    • High School Diploma or equivalent required with a minimum of two years of medical billing experience or an Associate’s Degree in Medical Billing and Coding or Health Information Management without prior experience. Certified Professional Coder (through AAPC) preferred. Candidates must be able to work with high volume of work while maintaining attention to detail and accuracy and demonstrate excellent oral and written communication skills. Computer skills required to operate practice management system (i.e., use Window operating system, conduct Internet searches, communicate by email, etc.)

PI258595731