Role Description We are seeking a highly motivated, detail-oriented, and experienced Medical Biller to a growing orthopedic practice. This role is not about passive data entry; it is a dynamic position focused heavily on Accounts Receivable (AR) cleanup, proactive eligibility troubleshooting, and root-cause denial resolution. The ideal candidate will manage the billing lifecycle for two of our four busy office locations, collaborating closely with an existing eligibility partner, front-desk staff, and providers to stabilize and optimize our revenue cycle. Key Responsibilities - Core AR Cleanup & Denials Management - Aged Claims Resolution: Dive deep into the EMR system to audit, work, and successfully resolve outstanding claims and denials that have sat untouched past 30 days. - Root-Cause Fixing: Identify back-end denial trends (specifically regarding eligibility discrepancies and missing referrals) and implement front-end workflows to prevent recurrence. - Appeals & Follow-Ups: Aggressively pursue underpaid or denied claims with major commercial payers (Aetna, Anthem, UnitedHealthcare, Cigna) as well as state/third-party plans. - Financial Posting & Administrative Support - Payment Posting: Accurately process and post financial data into the EMR, including Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs). - Ancillary Tracking: Proactively communicate with physicians, surgeons, and medical assistants to hunt down missing clinical documentation (such as operative reports or prior authorizations) essential for claim payment. - Patient Collections: Directly accept and process patient payments securely over the phone. - Meticulous Documentation & Compliance - Rigorous Account Noting: Maintain a massive focus on highly detailed account noting. Every single touchpoint regarding the revenue cycle (e.g., insurance representative directives, patient promises to pay) must be thoroughly documented in the system so that any future reviewer has instant, unambiguous context. - Technical & System Skills - EMR Experience: Proficient in ModMed (Modernizing Medicine) is highly preferred (experience with similar platforms like eClinicalWorks, AthenaHealth, or Kareo will be considered). - Specialty Knowledge: Strong, functional knowledge of Orthopedic billing workflows, including common orthopedic CPT/ICD-10 coding combinations, modifiers, and specialized global surgical billing windows. - Insurance Portals: Expert familiarity with navigating major clearinghouses and payer portals (e.g., Availity, Optum, insurance-specific portals). - Operational & Behavioral Competencies - The "One Week Ahead" Mindset: A proactive organizational style. You naturally aim to audit schedules and verify complex benefits 5 to 7 days in advance to successfully absorb high-volume, same-day add-on appointments. - Radical Accountability & Direct Communication: An honest, transparent communicator who works collaboratively as a team player, addresses mistakes head-on to find immediate fixes, and seamlessly partners with upper management, clinic staff, and attorneys. - Bilingual Capability: Fluency in English and Spanish is highly valued to assist our diverse patient demographic with billing concerns empathetically. Qualifications - Experience in medical billing, particularly in orthopedic practices. - Proficiency in EMR systems, preferably ModMed. - Strong knowledge of CPT/ICD-10 coding and billing workflows. - Fluency in English and Spanish. Requirements - Detail-oriented with a focus on accuracy. - Ability to work collaboratively with various teams. - Strong communication skills. - Proactive problem-solving abilities. Benefits - Competitive salary. - Health insurance options. - Opportunities for professional development.

• Work assigned insurance accounts receivable with accuracy, efficiency, and a strong sense of ownership • Proactively follow up on outstanding claims and insurance denials to ensure timely resolution • Research, prepare, submit, and track insurance appeals, including ongoing appeal follow-up • Communicate effectively with insurance representatives to resolve claim issues and obtain payment • Apply strong organizational and time-management skills to prioritize daily workloads and meet deadlines • Interpret managed care contracts, including fee schedules and allowable amounts, to support collection efforts • Work confidently with non-participating providers and payer guidelines • Maintain a clear understanding of the insurance collection process and apply best practices consistently • Identify issues and resolve problems independently, using sound judgment and attention to detail

Role Description The RCM AR Specialist follows up on Claim Denials and overdue insurance balances using Explanation of Benefits (EOB) documents and reports. They are assigned a specific book of business based on Financial Class and Payers, working to support the field related to claim denials. Responsibilities Include, But Are Not Limited To, The Following: Daily Duties - Follows up on denied claims and no response within a timely manner. - Submits appeals related to contract rate variances with a discrepancy in allowed amounts; notifies Supervisor of payers for which this is a consistent problem. - Submits Medical Records when requested by the payer for claims processing determination. - Monitors and reviews Payer correspondence from the lockbox and faxes. - Monitors, reviews, and responds to Hub (field) communication inquiries within the 48-hour requirement. Account Follow-Up - Using data from the monthly aged accounts receivable report, calls payers or looks up claims status online to inquire about unpaid insurance claims that are 45 days old; records response or activity in the computer system “notes”. - Maintains detailed knowledge of practice management and other computer software as it relates to job functions. - Responds to written and telephone inquiries from insurance companies. - Builds and maintains relationships with personnel from assigned carriers. - Meets with Pod Lead/Supervisor regularly to discuss and solve reimbursement and insurance follow-up concerns. Other - Maintains detailed knowledge of practice management and other computer software as it relates to job functions. - Attends all meetings as requested including regular staff meetings. - Attends Medicare and other continuing education courses as requested. Pursues and participates in education to remain current with changes in the Healthcare industry. - Performs any additional duties as requested by RCM Leadership. - Completes all assigned AP training (such as CPR, OSHA, HIPAA, Compliance, Information Security, others) within designated timeframes. - Complies with Allergy Partners and respective hub/department policies and reports incidents of policy violations to a Supervisor/Manager/Director, Department of Compliance & Privacy or via the AP EthicsPoint hotline. - Models the AP Code of Conduct and demonstrates a commitment to the AP Compliance Program, standards, and policies. Qualifications - High school diploma or GED equivalent, required. - College education or trade school preferred. - Previous Medical Billing and Collections experience preferred. Preference for those with a minimum of eighteen months experience. - Comfortable using email and interacting with Internet applications. - Knowledge of practice management and Microsoft processing software. - Proven understanding of Explanation of Benefits forms, claim forms, and the insurance billing process. - Working knowledge of managed care, commercial insurance, Medicare, and Medicaid reimbursement. - Basic knowledge of CPT and ICD-10 coding. - Strong written and verbal communication skills. Requirements - Physical demands are moderate with occasional lifting of items weighing approximately 20-30 pounds. - Position requires prolonged sitting, some bending, stooping, and stretching. - Good eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment is also required. - Employee must have normal range of hearing and vision must be correctable to normal range to record, prepare, and communicate appropriate reports. - Working conditions are a professional office environment. If remote, must have functioning internet and be open to on-camera team calls. - Occasional evening or weekend work. Benefits - The salary range posted for this position is the national average; however, actual compensation may vary depending on geographic location, job-related knowledge, skills, and experience.

• Following up directly with commercial, governmental, and other payers to resolve claim payment issues. • Securing appropriate and timely reimbursement and response. • Identifying and analyzing denials, payment variances, and no response claims and acts to resolve claims/accounts. • Drafting and submitting technical and clinical appeals. • Providing support for all denial, no response, and audit activities. • Examining denied and other non-paid claims to determine the reason for discrepancies. • Communicating directly with payers to follow up on outstanding claims. • Files technical and clinical appeals, resolves payment variances, and ensures timely and accurate reimbursement. • Works with management to identify, trend, and address root causes of issues in the A/R. • Maintaining a thorough understanding of federal and state regulations, as well as payer specific requirements and takes appropriate action accordingly. • Documenting all activity accurately including contact names, addresses, phone numbers, and other pertinent information in the client’s host system and/or appropriate tracking system. • Demonstrating initiative and resourcefulness by making recommendations and communicating trends and issues to management.