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Orthofix transforms patient lives worldwide through medical technologies that heal musculoskeletal pathologies.
Health Claims Collections Specialist II
Location
United States
Posted
68 days ago
Salary
$23 - $26 / hour
Seniority
Mid Level
Job Description
Health Claims Collections Specialist II
Orthofix
• Independently manage a portfolio of high-priority and complex claims requiring advanced solutions and strategies. • Analyze denials, overpayments and underpayments to determine root cause; execute appropriate action plans including appeals, escalations and payer outreach. • Submit technical, clinical and medical necessity appeals at all levels (including external reviews) with supporting documentation. • Research payer contract language, LCD/NCD guidelines and policy updates; apply findings to claims resolution and communicate relevant changes to peers and leadership. • Identify payer trends (example, systemic rejections, denials, overpayments or underpayments) and escalate issues with supporting data to payer contacts and leadership. • Resolve escalated issues involving prepay audits, refund requests, rebills, recoupments and coordination of benefits discrepancies. • Manage HCFA returns and claim corrections, ensuring clean resubmission per billing guidelines. • Communicate effectively with leadership and cross-functional teams to resolve multifaceted claim barriers. • Ensure account documentation is accurate, detailed, and audit ready across all internal system. • Consistently meet or exceed departmental metrics related to productivity, quality, aging resolution, and cash recovery.
Job Requirements
- Minimum 2+ years of medical collection or revenue cycle experience with emphasis on post-billing DME or orthopedic claims.
- Advanced knowledge of payer guidelines, revenue cycle management, and appeals processes (Medicare, Medicare advantage, Medicaid, and commercial insurance payers).
- Proficiency in reading and interpreting EOBs, payer policies, LCDs, and prior authorization requirements.
- Strong working knowledge of ICD-10, HCPCs and billing procedures for CMS-1500 claim forms.
- Proficient in Microsoft Office and medical billing platforms.
- Demonstrated experience with complex denials, payer escalations, and appeals at all levels.
- Strong attention to detail with the ability to identify trends and implement corrective strategies.
- Excellent communication skills and negotiation skills with payers and internal stakeholders.
- Ability to work independently, Detail-oriented with a focus on accuracy, time-management and compliance.
- Familiarity with Oracle or similar revenue cycle platforms.
Benefits
- Health insurance
- Paid time off
- Professional development
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