What are the responsibilities and job description for the Orthopedic Certified Biller/Coder position at SOUTHLAND ORTHOPAEDICS LTD?
Experienced F/T or P/T Orthopedic Biller/Coder and Revenue Cycle Specialist wanted to join Southland Orthopaedics Ltd in Olympia Fields, Illinois. The ideal candidate should possess a comprehensive understanding of billing processes, coding procedures, and revenue cycle management in an orthopedic private practice.
This role involves ensuring accurate claim submission, effective revenue collection, and compliance with healthcare regulations.
Responsibilities
- Prepare and submit accurate insurance claims using CPT (Current Procedural Terminology), coding systems to ensure proper reimbursement for office visits and surgeries, DME, physical therapy, and W/C efficiently to ensure timely submission.
- Manage A/R regularly by following up on unpaid claims and resolving denials with payors.
- Utilize eClinical Works EMR (Electronic Medical Records) and Trizetto Clearinghouse for claims submission.
- Collaborate with clinical staff for any documentation requirements for proper coding and billing procedures.
- Ensure compliance with healthcare regulations, payer policies, and industry standards related to medical billing and collections.
Qualifications
- Minimum 3 year experience working in Billing / Revenue Cycle in an orthopedics practice - preferred.
- Certified Professional Coding working knowledge base for Orthopaedic surgery, procedures and physical therapy - required.
Preferred Skills
- Oversee the revenue cycle billing operations & analyze monthly A/R reports to maintain an efficient revenue stream.
- Monitor daily orthopedic billing operations, including successful claim submission (paper or electronically), ensuring all billing is processed and completed daily.
- Follow up on rejected claims on the day that the rejected EOB is received.
- Monitor A/R appeals closely with the objective of securing payment on denials within 90 days.
- Using data from Aging A/R report, contact Payers and/or look up claims status online to inquire about unpaid insurance claims that are > 60-90 days and document all communications.
- Follow thru with necessary medical records/documentation requests, and/or completion of additional paperwork, if payer requests this information prior to payment of claims.
- Respond in timely manner to all written and telephone inquiries from payer.
- Work with orthopedic surgeon, PT provider to provide appeal language pertaining to specific denials, or to support medical necessity.
- Process requests for refunds w/ provider(s).
We are seeking a dedicated, organized individual who can work collaboratively with team members to optimize our financial performance while maintaining high standards. Attention to detail and good analytical skills to problem solve and work efficiently is essential.
Excellent compensation package offered based on experience and qualifications.
- 401(k)
- Health insurance
- Paid time off
Work Location: In person