Medical Billing Specialist for Orthopedic Medical Group

RESPONSIBILITIES and DUTIES:

• Manages the end-to-end debt collection process for all assigned payer accounts within the Accounts Receivable (AR) portfolio.
• Initiates patient outreach as needed to obtain updated demographic or insurance information, and to discuss outstanding balances and patient financial responsibility.
• Proactively addresses claim rejections, perform necessary corrections and rebilling, follows up on partial payments, non-responses, and initiates appeals as appropriate.
• Engages with payers via phone or other channels to ensure timely and accurate resolution of claims.
• Reviews and disputes payment variances in accordance with payer contracts, ensuring compliance and optimal reimbursement.
• Maintains comprehensive documentation of all communications and activities in the electronic medical record (EMR) system.
• Collaborates with clinic staff and leadership to identify and escalate denial trends, contributing to root cause analysis and process improvement.
• Partners with management to develop and implement strategies to prevent denials and improve collections.
• Serves as a resource to staff, management, and leadership by addressing questions related to assigned payers, trends, and claim resolution.
• Provides timely reports to management on denial patterns and payer issues to support operational decision-making.
• Follows up on unresolved payer issues to ensure complete resolution and appropriate follow- through.
• Perform adjustments to uncollectible balances in accordance with departmental policies and sound judgment.
• Submits required documentation and progress notes to payers to support claims and appeals as needed.
• Maintains strict confidentiality and compliance with HIPAA regulations in handling Protected Health Information (PHI).
• Ensures compliance with all applicable federal, state, and local regulations, as well as internal company policies and procedures.
• Completes all other billing tasks assigned