Revenue Cycle Specialist - Columbia Orthopaedic Group

Job Title: Revenue Cycle Specialist

Location: Columbia Orthopaedic Group

Job Summary:

The Revenue Cycle Specialist is responsible for managing the revenue cycle processes, including charge entry, claims review, and handling claims for orthopedic services, anesthesia, durable medical equipment (DME), and radiology. This role ensures accurate and timely billing, claim submission, and payment processing while working to resolve claim denials and rejections.  

Key Responsibilities:

1. Charge Entry:

   • Accurately enter and verify charges for orthopedic, anesthesia, DME, and radiology services into the billing system.
   • Ensure all charges reflect the services provided, including proper coding and documentation.
   • Review and correct charge data as needed to ensure accuracy and compliance with payer requirements.

2. Claims Review and Submission:

   • Prepare, submit, and track insurance claims for orthopedic, anesthesia, DME, and radiology services using appropriate billing software.
   • Verify that all claims are submitted in accordance with payer guidelines and coding standards.
   • Review and resolve any issues or discrepancies identified during the claim submission process.

3. Claims Follow-Up and Resolution:

   • Monitor and follow up on outstanding claims, denials, and rejections to ensure timely resolution and payment.
   • Investigate claim denials and rejections by reviewing claim history, communicating with insurance carriers, and making necessary corrections or adjustments.
   • Collaborate with the billing team and healthcare providers to gather additional information or documentation needed for claim resolution.

4. Compliance and Documentation:

   • Stay current with insurance policies, billing regulations, and compliance requirements specific to orthopedic, anesthesia, DME, and radiology services.
   • Ensure all billing and claims processes comply with federal, state, and payer-specific regulations and guidelines.
   • Maintain accurate and thorough documentation of all claim-related activities and communications.

5. Reporting and Analysis:

   • Generate and analyze reports related to charge entry, claim status, denials, and reimbursement trends for orthopedic, anesthesia, DME, and radiology services.
   • Identify and address any trends or issues affecting the revenue cycle and provide recommendations for improvement.

6. Patient Interaction:

   • Communicate with patients regarding their insurance coverage, claim status, and any outstanding balances.
   • Address patient inquiries and concerns related to billing and claims.

Qualifications:

• Education: High school diploma or equivalent required; Associate's or Bachelor's degree in Healthcare Administration, Business, or a related field preferred.
• Experience: Proven experience in medical billing and coding, preferably in an orthopedic, anesthesia, DME, or radiology setting.
• Skills:
  • Proficiency in medical billing software and electronic health record (EHR) systems.
  • Strong understanding of billing processes and coding for orthopedic, anesthesia, DME, and radiology services (CPT, ICD-10, HCPCS).
  • Excellent communication, analytical, and problem-solving skills.
  • Ability to manage multiple tasks and prioritize effectively.

Certifications (Preferred):

• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS).
• Certification in medical billing and coding (e.g., AAPC, AHIMA).
• Pay Differential: Employees who maintain a relevant certification (CPC, CCS, etc.) will receive a pay differential of $2.00 above the base rate.

Working Conditions:

• Environment: Office setting within the orthopedic practice.
• Hours: Full-time position, typically Monday to Friday with standard office hours.

Additional Information:

• Hybrid Work Opportunity: After successfully completing six months of employment and meeting performance expectations, there is potential for a hybrid work arrangement, combining remote work with in-office responsibilities.

The Revenue Cycle Specialist will work closely with the billing team, healthcare providers, and insurance representatives to ensure the practice’s revenue cycle operates efficiently and effectively. This role requires a high level of attention to detail, strong organizational skills, and the ability to handle sensitive information with confidentiality.