Columbia Orthopaedic Group

Job Title: Revenue Cycle Specialist

Location: Columbia Orthopaedic Group

Job Summary:

Responsible for managing revenue cycle processes, including charge entry, claims review, and claims handling for orthopedic services, internal medicine, anesthesia, durable medical equipment (DME), and radiology. Ensures accurate billing, timely claim submission, and payment processing while resolving claim denials and rejections.

Key Responsibilities:

• Charge Entry:
  • Enter and verify charges for orthopedic, internal medicine, anesthesia, DME, and radiology services.
  • Ensure proper coding and documentation.
  • Review and correct charge data for accuracy and compliance.
• Claims Review & Submission:
  • Prepare, submit, and track insurance claims using billing software.
  • Ensure compliance with payer guidelines and coding standards.
  • Resolve claim submission issues or discrepancies.
• Claims Follow-Up & Resolution:
  • Monitor and follow up on outstanding claims, denials, and rejections.
  • Investigate denials, communicate with insurers, and make necessary corrections.
  • Collaborate with billing team and providers to gather documentation.
• Compliance & Documentation:
  • Stay updated on insurance policies, billing regulations, and compliance requirements.
  • Ensure billing and claims processes align with regulations.
  • Maintain thorough documentation of all claim-related activities.
• Reporting & Analysis:
  • Generate and analyze reports on charge entry, claim status, denials, and reimbursement trends.
  • Identify revenue cycle trends and provide recommendations for improvement.
• Patient Interaction:
  • Communicate with patients about insurance coverage, claims, and outstanding balances.
  • Address patient inquiries and billing concerns.

Qualifications:

• Education: High school diploma required; Associate’s/Bachelor’s in Healthcare Administration, Business, or related field preferred.
• Experience: Medical billing and coding experience, preferably in orthopedic, internal medicine, anesthesia, DME, or radiology settings.
• Skills:
  • Proficiency in medical billing software and EHR systems.
  • Strong understanding of billing processes and coding (CPT, ICD-10, HCPCS).
  • Excellent communication, analytical, and problem-solving skills.
  • Ability to manage multiple tasks and prioritize effectively.

Certifications:

• Certified Professional Coder (CPC).
• Medical billing and coding certification (AAPC preferred).

Working Conditions:

• Environment: Office setting within the orthopedic practice.
• Hours: Full-time, Monday to Friday with standard office hours.

Additional Information:

• Hybrid Work Opportunity: Eligible after six months of employment and satisfactory performance.
• Works closely with billing team, providers, and insurers to ensure revenue cycle efficiency.
• Requires attention to detail, strong organizational skills, and confidentiality.