Orthopedic Medical Biller (Ancillary Services) – Orthopedic/PT Office
Position Summary
Medical Billing Representative specializing in ancillary orthopedic care such as Physical Therapy, DME and Viscosupplementation while ensuring compliance with billing regulations and insurance requirements.
Location: Linden, NJ
Pay: Starting $22- $26/hr
Schedule:
- Full time, Monday to Friday
- 8am – 4:30pm
- 30 minute lunch break
Requirements:
Critical Skills & Attributes
- High School Diploma or GED/equivalent required
- A committed and result-driven attitude to work as a high ethical and professional standard
- Unquestionable commitment to confidentiality, quality customer service and professionalism
Industry Experience
- Minimum of 18 months experience in a physician group practice billing department
- Familiar with CPT and ICD-10-CM coding for orthopedic, podiatry & pain management procedures
- Good analytical skills and an affinity for detail
- Knowledge of HIPPA & OSHA guidelines
- Working knowledge of medical practice management systems and electronic medical records
- Basic knowledge of computers and medical terminology is mandatory
Communication Skills:
- Excellent verbal, written, and interpersonal skills
- Ability to work well with physicians, employees, patients, and others
Key Responsibilities:
- Claims Processing & Management
- Process and submit all paper and electronic claims for assigned carriers
- Review edit reports from clearinghouse daily and resolve issues
- Follow up on rejected claims immediately upon receipt of rejected EOB
- Verify completeness of insurance claim information before submission
- Manage specialized billing for:
- Physical therapy services
- Occupational therapy services
- Orthopedic DME billing
- Viscosupplementation/gel injections
- Orthopedic, Pain management & Podiatry services
Account Follow-Up
- Monitor unpaid insurance claims at 45 days using monthly aged accounts receivable report
- Call medical insurance carriers and/or check portals to follow up on claims
- Record claims actions in Practice Management System
- Coordinate medical records requests and additional documentation
- Appeal payments that don’t match contractual agreements
- Process insurance refund requests
- Monitor payor policy/guideline updates
Patient Accounts & Collections
- Establish payment plans within approved guidelines
- Process patient refund requests
- Manage patient A/R and statement processing
- Print and mail itemized statements as requested
- Evaluate accounts for outside collections
- Assist patients with claims processing inquiries
Payment Posting
- Post adjustments and withholds according to protocol
- Transfer deductibles and coinsurance to patient responsibility
- Monitor contractual payment amounts
- Identify underpayments and silent PPOs
- Submit balanced payment batches daily
- Post mailed and electronic payments as needed
General
- Ensure all medical information for patient is accurate, updating when necessary
- Check patient eligibility and benefit verification; update account if discrepancies
- Document all actions taken; scan all documents sent out to payors (ex: appeals paperwork)
- Work with other departments to ensure that bills are processed accordingly
Shared Duties/Other:
- Ensures that all faxes are cleared off the machine (or routed in the system) and distributed throughout the day
- Sorts incoming reports and directs to appropriate person if not addressed properly
- Maintains detailed knowledge of practice management and other computer software as it relates to job functions
- Maintains and respect the confidentiality of patient information in accordance with company policy & procedure, and HIPAA & compliance guidelines
- Attends regular staff meetings and continuing education sessions as requested
- Presents professional image in manner, appearance, motivation and work habits
- Regular attendance is required
- Performs other duties as assigned
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