What are the responsibilities and job description for the Medical Collections Specialist position at Bay Orthopedic?
Job Summary
We are seeking a detail-oriented and experienced Part-time medical billing & collections specialist to manage insurance accounts receivable, with a specific focus on Worker's Compensation (WC) and No-Fault (NF) auto insurance claims. The ideal candidate can easily navigate insurance portals, interpret complex claims data, and proactively resolve payment delays or denials to maximize revenue recovery.
Responsibilities
- Insurance Follow-up & AR Management: Monitor outstanding accounts receivable, track aging claims and proactively contact Worker's Compensation and No-Fault adjusters to secure payments.
- Coding & EOB Interpretation: Review, analyze and interpret medical procedure codes, CPT codes, and Explanation of Benefits (EOB) to identify denial reasons or underpayments.
- Appeals Submission: Draft, compile and submit comprehensive appeal letters alongside necessary supporting documentation (medical records, notes) to challenge wrongful insurance denials
- Eligibility Verification: Utilize various payer web platforms and insurance portals to run real-time eligibility and benefits verifications.
- HP-1 Filing: Accurately prepare, complete, and file HP-1 forms (Notice of Decision) with Worker's Compensation Board and follow up through payment resolution.
- Account Documentation: Maintain meticulous, clear and up-to-date notes of all collection activities, adjustor communications, and claim statuses within the billing systems.
Qualifications & Skills
- Required Experience: Minimum of 1-3 years of hands-on experience in medical billing, insurance collections, or accounts receivable management.
- Specialized Knowledge: Proven, strong expertise in Worker's Compensation (WC) and No-Fault (NF) insurance guidelines and regulations.
- Technical Proficiency: Must know how to complete and process HP-1 filings and navigate insurance clearinghouses/portals.
- Analytical Skills: Expert-level ability to read and decipher CPT codes, procedure codes and complex EOB forms.
- Preferred (Plus): Prior knowledge or familiarity with the No-Fault (NF) Arbitration process is highly helpful but not strictly required.
- Soft Skills: Strong communication skills for negotiating with insurance adjusters, high attention to detail, and the abilityto work independently in a part-time structure.
Pay: From $25.00 per hour
Expected hours: No more than 40.0 per week
Benefits:
- 401(k) matching
- Health insurance
- Life insurance
- Paid time off
- Retirement plan
- Vision insurance
Work Location: In person
Salary : $25