Orthopaedic Specialty Institute Medical Group of Orange County

Role Description This position is responsible for collecting payments from insurance companies ensuring that the company receives correct payments for the medical services rendered. The position is a Full-Time Non-Exempt position. Essential Job Functions: - Investigate rejected/underpaid claims; resolve issue(s) and resubmit claims - Prepare appeal letters to insurance carrier when not in agreement with claim denial - Create insurance aging report using the medical practice billing software; these reports are used to identify unpaid insurance claims - Understanding of EOB payment posting on insurance and patient payments - Understanding of HMO, PPO Networks, Medicare, Medicaid, Worker Compensation and other third-party carriers - Share knowledge by communicating with clinical staff regarding updated insurance policies and guidelines - Perform other related duties and special projects as assigned Expectations: - Maintain confidentiality; adhere to all HIPAA guidelines/regulations - Prioritize tasks by level of importance to meet deadlines - Work cooperatively in a team atmosphere - Maintain workflow and follow company’s policies and procedures - Participate in professional development activities to keep current with healthcare trends and attend weekly staff meeting Qualifications - High School Diploma required - Basic computer skills required - Minimum of two years of experience working in a healthcare billing and/or collections department required - Experience in orthopaedic field is preferred Requirements - Understanding of full billing and collections cycle - Understanding of EOB payment posting, HMO, PPO Networks, Medicare, Medicaid, Worker Compensation and other third-party carriers - Understanding of medical practice systems - Knowledge of coding classification including CPT, ICD-10-CM, HCPCS - Knowledge of medical billing, collections, and appeals process Skills - Great verbal and written communication skills - Analyzing, planning, organizing, and prioritizing - Cooperation – being a team player - Problem solving; taking initiative and making sound judgment independently Abilities - Ability to read and interpret medical billing code - Ability to set priorities among multiple requests - Ability to interact easily and effectively with others Equipment Operated - Standard office equipment including computers, fax machines, copiers, printers, telephones, etc. Work Environment - Position may be in either a well-lighted office or home environment Mental/Physical Requirements - Involves sitting approximately 90 percent of the day, walking or standing the remainder