ORTHOLONESTAR MSO LLC

Role Description Medical Billing Workers' Compensation AR Specialist will be well versed in all facets of an accounts receivable management system including but not limited to billing, claim corrections, reconciliation, Insurance refunds/credit balances, customer service, and follow-up. This includes reviewing claim information to ensure accuracy and provide feedback to the clinical and non-clinical areas regarding claim errors and/or denials. In addition, responsible for all other aspects of collections, resolving customer billing problems and reducing accounts receivable delinquency. Medical Billing Workers' Compensation AR Specialist will work remotely. Essential Functions - Medical Billing Workers' Compensation A/R Clean up, Collections and Review. - Follow-up on all returned claims, correspondence, denials, account reconciliations and rebills to achieve maximum reimbursement in a timely manner with an emphasis on patient satisfaction. - Mail correspondence to insurance carrier for payment of claims in the form of claim review and/or appeals according to carrier guidelines. - Review and monitor assigned accounts and all applicable collection reports. - Follow-up claim reviews and appeals with insurance carriers. - Scan and fax documents pertaining to patient accounts received from carriers. - Actively searches for solutions to problems and presents ideas and recommendations to Management. - Retroactive verification of eligibility. - Always attempt to verify inaccurate/missing information. - Other duties as assigned. Qualifications - High School Diploma or equivalent. (Required) - 1 year of experience in Workers' Compensation Billing and AR collections; preferably in physician office setting. - Medical Appeals and Denials: 1 year. (Required) - Minimum of 1 year’s knowledge of insurance verification and eligibility experience. (Required) - Spine/Orthopedic medicine billing knowledge and experience (Preferred) - Knowledge and experience with Athena EMR. (Preferred, but not required) Special Skills - Knowledge of medical and insurance terminology. - Attention to detail. - Ability to effectively communicate both orally and written. - Ability to work in a fast-paced environment. Physical Demands - Must have adequate visual acuity to read, the ability to interpret and understand written material. - Ability to sit for extended periods. - Repetitive movement of fingers and hands. - Reaching with hands and arms. - Ability to lift 10-20 pounds. - Read, evaluate, and interpret data. - Data entry. - Perform mathematical functions. Environmental Working Conditions - Continuously manage multiple tasks simultaneously and work as a part of a team. - Remote office environment.

Role Description Handles verification of injury/claim of all WC patients including auditing medical record for billing accuracy. Responsible for marketing to employers/WC clinics and is the point of contact for adjustors and case managers. Essential Functions - Call adjustors to verify all new and established WC injuries/claims per protocol - Audit WC appointments for comments/authorization/DWC - Prepare claims and documentation for filing - Point of contact for all adjustors and case managers - Facilitate physician’s use and understanding of ODG - Prepare DWC 73’s & 69’s - Authorization of all WC procedures - Timely follow up on appeals for unpaid claims utilizing claims maintenance - Advise physicians on dispute cases including initiating Benefit Review Conferences - Remain up to date on DWC rules – including ODG treatment, RTW, Preauthorization and fee guidelines - AR follow up to ensure claims are paid timely - All other duties as assigned Qualifications - High School Diploma - Three years medical office WC billing experience - Knowledge of Texas Workers’ Comp ODG treatment, RTW and fee guidelines - Excellent computer knowledge and skills - Ability to effectively communicate both orally and written - Adequate visual acuity to read written materials - Ability to sit for long periods of time - Problem solving skills - Attention to detail Physical Demands - Telephone – with or without headset – constantly - Photocopier – frequently - Computer – constantly - Fax machine – frequently Environmental Working Conditions - Indoors with rare conditions of extreme noise - Rare conditions of chemicals/fumes/odors and dust/messiness - Continuously handle multiple tasks simultaneously and work as part of a team - Occasionally perform tedious and exacting work in frustrating conditions

Job DetailsLevel: ExperiencedPosition Type: Full TimeEducation Level: High School/GEDSalary Range: $18.00 - $21.00 HourlyJob Category: Health Care Job Summary: Responsible for reviewing and submitting claims on a daily basis. Essential Duties and Responsibilities: The essential duties of the position include the following. Other duties may be assigned. Key Functions: Prepares and submit clean claims to various insurance companies either electronically or on paper. Contact carriers by phone or website for claim status on outstanding insurance balances. Process and work all insurance correspondence. Perform various collection actions including contacting patients by phone, correct and resubmitting claims to other carriers. Obtain necessary documentation required to submit to insurance to expedite payments. Answers questions from patients, clerical staff and insurance companies. Identify and resolve patient billing complaints. Prepare appeal letters for all claims that are denied for payment. Document all collection activities using guidelines in place. Identify underpayments by checking payments received against our contracted fee schedule. Work and process all insurance refund requests. Report payer issues or delays to supervisor. Participate in educational activities Maintains strict confidentiality; adhere to all HIPAA guidelines/regulations. Team Player with ability to solve problems and recommend solutions. Must be able to manage assigned workload and prioritize accordingly. Maintain accurate and timely reconciliation of accounts receivable. Review claims stopped in the claim scrubber. Work Claims rejected by the clearinghouse. Supervisory Responsibilities: None. Qualifications Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education/Experience: High School Diploma or GED, and minimum one year experience in a medical billing/collections field. Language Ability: Ability to write and read Math Ability: Ability to add, subtract, multiple and divide on all units of measure, using whole numbers, common fractions and decimals. Reasoning Ability: Ability to read and interpret explanation of benefits remittances to determine and identify claim denial reasons and necessary course of action for resolutions. Computer Skills: Ability to type 45 WPM, basic proficiency in Microsoft Outlook/Office, and experience using or ability to learn and comprehend computer programs. Certificates and Licenses: None Work Environment: Position works in a climate-controlled office environment in a cubicle setting. Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Job DetailsLevel: ExperiencedJob Location: Houston, TX 77030Position Type: Full TimeEducation Level: High School/GEDJob Category: Health CareThe Customer Service Representative is responsible for handling patient and payer inquiries regarding medical billing, insurance claims, and account resolutions. This role ensures a positive patient's financial experience by providing timely, professional, and accurate responses to billing-related concerns. The Customer Service Representative works under the direction of the Revenue Cycle Manager Patient AR to support revenue cycle operations and enhance the efficiency of billing processes. Essential Duties and Responsibilities Handle inbound and outbound calls regarding patient balances, insurance claims, and billing inquiries. Provide clear and empathetic explanations of charges, payment options, and account statuses. Assist patients with setting up payment plans and making payments. Research and resolve billing discrepancies, denials, and adjustments. Work with insurance carriers to verify claims status and escalate issues as Maintain a professional and courteous demeanor in all patient interactions. Ensure timely and effective resolution of patient and payer concerns. Document all customer interactions accurately in the system. Adhere to HIPAA guidelines and company policies regarding patient information security. Follow Fair Debt Collection Practices Act (FDCPA) guidelines when addressing outstanding balances. Work closely with the billing, collections, and revenue cycle teams to improve patient financial engagement. Provide feedback to management on recurring billing issues and recommend solutions. Participate in training and team meetings. Support special projects related to billing and collections. QualificationsQUALIFICATIONS Education & Experience High school diploma or GED required. Minimum of 1 year of experience in healthcare customer service, billing, or insurance claims processing. Skills & Competencies Excellent verbal and written communication skills. Basic knowledge of orthopedic-related coding, medical terminology, and insurance procedures preferred. Proficiency in Microsoft Office (Excel, Word, Outlook) and Athena software. Ability to handle high call volumes and work in a fast-paced environment. Strong problem-solving and conflict-resolution skills. High attention to detail and ability to follow workflows accurately. Work Environment & Physical Demands: Standard office environment with prolonged periods of sitting and computer use. Occasional high-stress work requiring interaction with upset patients or insurance representatives. Manual dexterity required to operate a keyboard, calculator, and office equipment.

Job DetailsLevel: ExperiencedPosition Type: Full TimeEducation Level: High School/GEDJob Category: Health CareDivision/Department – MSO Reports to – Revenue Cycle Manager-Quality Assurance & Payment Integrity GENERAL JOB DESCRIPTION Reports directly to the Revenue Cycle Manager and is responsible for accurately posting patient and insurance payments into the Practice Management System. The Payment Application Specialist ensures timely and correct allocation of payments, helps resolve unapplied or misposted transactions, and works closely with both internal teams and external contacts such as insurance companies. Additional responsibilities are outlined below. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES • Accurately post all patient and insurance payments to the correct accounts. • Balance and reconcile daily deposits and batches. • Research and resolve unapplied or misapplied payments in a timely manner. • Request missing remittance advice from insurance payers and download ERAs. • Coordinate receipt and processing of correspondence related to payment posting. • Monitor and manage unapplied balances, escalating issues when necessary. • Support teammates and assist with training as needed. • Promote and adhere to OrthoLoneStar’s mission, core values, and vision. • Maintain satisfactory attendance in accordance with policy. • Other duties as assigned. QualificationsKNOWLEDGE, SKILLS, AND ABILITIES Education – High School Diploma or equivalent work-related history. College education or trade school preferred. Experience - Previous experience with payment posting in a physician group or healthcare setting preferred. Licensure - None Required Special Skills • Familiarity with healthcare payment posting processes and terminology. • Basic knowledge of CPT, ICD-10, and HCPCS is a plus. • Understanding of third-party payer payment and remittance structures. • Strong organizational and time management skills. • High attention to detail and accuracy. Proficient computer and data entry skills. • Ability to maintain confidentiality and handle sensitive information according to HIPAA regulations. • Effective communication and teamwork skills. Working Conditions and Requirements High quality and reliable internet to perform remote duties efficiently. Remote, work-from-home setting with a 40-hour work week, Monday through Friday. Overtime is available, if necessary. Equipment is provided but must be placed in a secluded environment. Adequate childcare during work hours. Physical Demands Requires manual dexterity to operate a keyboard, calculator, and other office equipment. Near-visual acuity with color perception in order to view computer screens and decipher fine print. Auditory acuity for hearing telephone conversations or team meetings. Frequent sitting and use of standard office equipment. Ability to lift 15 pounds of office supplies or equipment, if necessary.

Role Description Reports directly to the Revenue Cycle Manager and is responsible for ensuring all patient visits are entered into the Practice Management System with appropriate and accurate ICD-10 and CPT codes. The charge capture specialist will be the immediate liaison for documentation improvement and optimization for revenue and compliance purposes. They will also have interactions with providers and their medical office staff within the MSO. Other responsibilities include: - Ensures accurate billing of services provided by OLS providers, including assigning the correct ICD-10 and CPT codes, modifier usage, and knowledge of NCCI edits. - Review documentation thoroughly in order to maintain high-quality results for submission of clean claims. - Reviews pending missing billing slips and ensures appropriate follow-up as necessary for timely billing. - Review DME reports daily to ensure appropriate billing. Correspond and coordinate with medical staff to escalate any issues. - Able to maintain quantity and quality goals for metrics in place. - Attends regular staff meetings, as requested. - Promote and adhere to OrthoLoneStar’s mission, core values, and vision. - Maintain satisfactory attendance in accordance with policy. - Other duties as assigned. Qualifications - High School Diploma or equivalent work-related history. - College education or trade school preferred. - Certified Professional Coder, Certified Coding Specialist, or Certified Medical Coder preferred. - Experience with Physical Therapy or Orthopedic coding preferred. - Minimum 1 year experience working in a physician group practice billing department preferred. - No licensure required. Requirements - Extensive knowledge of CPT, ICD-10 and HCPCS coding conventions. - Appropriate knowledge of CMS guidelines and ability to apply them accurately. - Extensive knowledge of anatomy, physiology, and medical terminology. - Knowledge of third-party payer reimbursement guidelines. - Strong written and verbal communication skills. - Computer literate, with keyboard skills and operational knowledge preferred. - Ability to maintain the confidentiality of sensitive information according to HIPAA. - Skill in establishing and maintaining effective working relationships with other employees, patients, and organizations. - Close attention to detail and ability to work in a fast-paced environment, which may include pressure generated by deadlines and peak workload periods. Working Conditions and Requirements - High quality and reliable internet to perform remote duties efficiently. - Remote, work-from-home setting with a 40-hour work week, Monday through Friday. Overtime is available, if necessary. - Equipment is provided but must be placed in a secluded environment. - Adequate childcare during work hours. Physical Demands - Requires manual dexterity to operate a keyboard, calculator, and other office equipment. - Near-visual acuity with color perception in order to view computer screens and decipher fine print. - Auditory acuity for hearing telephone conversations or team meetings. - Frequent sitting and use of standard office equipment. - Ability to lift 15 pounds of office supplies or equipment, if necessary.