Job Title - Out-of-Network Medical Biller - Orthopaedic Spine Surgery

Responsible for all activities related to resolving, monitoring, and appealing claim denials received from Third Party Payers. Assisting with the appropriate and accurate coding of Orthopedic Spine Surgical Reports.

DUTIES INCLUDE BUT ARE NOT LIMITED TO:

• Review, identify and resolve underpaid and denials from payers.
• Prepare appeals for the underpaid and denied claims.
• Ensure adjustments are posted timely and correctly for claims that were paid satisfactorily and/or exhausted after appeal process. All adjustments for denied claims need management approval.
• Track and follow up on appealed claims.
• Track and follow up on requests for refunds or recoupments in accordance with payer requirements.
• Performs other duties as assigned.

KNOWLEDGE, SKILLS & ABILITIES (This position requires the following minimum requirements)

QUALIFICATIONS

To perform this job successfully, the individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Clear understanding and working knowledge of OON billing, the NSA, and IDR processes.
• Clear understanding of Healthcare claims processing, payer denials, and appeals process.
• Ability to work independently as well as in a cross-functional team environment by collaborating with others and sharing tools, skills, and knowledge.
• Solid problem-solving and analytical skills that demonstrate resourcefulness and attention to detail.

LANGUAGE SKILLS

Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers and employees.

MATHEMATICAL SKILLS

Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, and percentages.

REASONING ABILITY

Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

EDUCATION / EXPERIENCE

High school diploma or equivalent; and a minimum of one year collection experience in a surgical medical office environment. Orthopedic preferred. A comprehensive knowledge of insurance carriers is required.

PHYSICAL DEMANDS / WORKING CONDITIONS

The physical demands described here are representative of those that must be met to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms; and talk and hear. The employee is occasionally required to stand and walk. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, color vision, and ability to adjust focus.

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off

Schedule:

• Monday to Friday

Work Location: In person