The Revenue Cycle Specialist works with insurance carriers regarding claim status and denial management. Follows Florida Orthopaedic Institutes policy and procedures along with applying federal and state guidelines to collection efforts. Interprets and follows up on Explanation of Benefits. Assuring timely collection of accounts receivable, monitoring the account activity and providing adequate follow- up to ensure maximum reimbursement is received. Maintaining Quantity & Quality of assigned work.

Key Responsibilities:

• Takes appropriate actions on denied charges to ensure claims are paid on the first follow-up call or appeal.
• Works with assigned queues, aging and denial reports to accomplish the set goal for the position.
• Responsible for learning, understanding and following payer guidelines.
• Notifying management of payer policy changes.
• Ensuring appropriate information is submitted to insurance companies in order to expedite payment.
• Completes appropriate adjustments and refund requests based on contract, modifiers or appeal denials.
• Handle incoming calls for information request from insurance companies and patients.
• Works to understand the operative notes that dictate procedures billed.
• Reallocate misapplied payments and adjustments.
• Work special assignments when needed.
• Utilizes the coding resources (CPT, ICD-10, CDR, AAOS books) to understand procedures that are denied.
• Documents accounts correctly.
• Assure compliance with all company plans, policies and procedures set forth by the Florida Orthopaedic Institute
• All other duties as assigned.

Qualifications

• High School Diploma or general education degree (GED).
• Knowledge of medical terminology & medical billing. Insurance collection and denial process experience (minimum of 2 years)
• Excellent telephone etiquette and communication skills (written and verbal)
• Basic computer skills (Microsoft Office Suite, general EMR knowledge, payer website).