Description:
Join our respected medical practice as our Billing & Collections Representative, where your exceptional attention to detail and revenue cycle expertise will ensure our financial health while providing patients with clear financial guidance.
We're seeking an experienced professional who can masterfully navigate insurance claims, patient accounts, and collection processes while maintaining the highest standards of accuracy and compliance.
If you thrive in a collaborative healthcare environment and take pride in resolving complex billing challenges with both efficiency and empathy, we offer competitive compensation, professional growth, and the satisfaction of being an essential member of our patient-centered team.
This is NOT a remote position. It is in-person at our Linden, NJ location
Requirements:
Key Responsibilities include the following:
Charge Entry
Posts missing charges when discovered
Claims Filing
Reprocesses all paper and electronic claims for assigned carriers when required — verifies completeness of insurance claim information before sending
Reviews edit reports from clearinghouse daily and resolves issues so claims can be processed
Follows up on rejected claims the day that the rejected EOB is received
Claims Account Follow-Up
Using data from the monthly aged accounts receivable report, calls payors or looks up claims status online to inquire about unpaid insurance claims that are 45 days old; records response or activity in the computer system "notes"
Makes necessary arrangements for medical records requests, completion of additional paperwork, etc., if payors request this information prior to payment of claims
Responds to written and telephone inquiries from patients and insurance companies; manages relationships with personnel from assigned carriers
Meets with Billing Manager regularly to discuss and solve reimbursement and insurance follow up problems
Calls carriers to appeal payments that do not match contractual agreement; notifies Billing Manager of payors for which this is a consistent problem; works with Billing Manager and physicians to obtain appeal language for denials and/or unacceptable payment
Processes requests for insurance refunds, and submits to Billing Manager for approval
Check payors monthly updates on medical policy/guidelines and report to supervisor
Patient Accounts
Establishes payment plans within approved guidelines—obtains approval from the Billing Manager when necessary
Resubmits insurance claims on behalf of patients, if necessary
Recommends to Billing Manager those accounts needing to go to an outside collection agency and sends out collection letters
Prints and mails itemized statements to those patients who request them, or transmits claims to outside mailing house for processing
Processes requests for patient refunds, and submits to Billing Manager for approval
Meets with Billing Manager, as necessary, to discuss and solve collection problems • Assist patients on claims processing if needed
Payment Posting
Posts adjustments, withholds, as part of this process, and transfers deductibles and coinsurance to patient responsibility; batches them according to protocol
Alerts Billing Manager when payments do not match contractual amounts; looks for underpayments and silent PPOs
Submits balanced payment batches to the Billing Manager daily
May be required to post all mailed-in payments and electronic payments by line item (in absence of Poster)
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)
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
Critical Skills & Attributes
Academic/Technical Qualifications
HS diploma or GED required
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 surgery 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
A committed and result-driven attitude to work as a high ethical and professional standard
Unquestionable commitment to confidentiality, quality customer service and professionalism
OrthoNJ, LLC is required by New Jersey law to include the salary range for this role. The hourly hiring range for this role is $18-$29. The range for this role is typically determined by several factors, including the geography in which the selected candidate will be working, and alignment with qualifications and experience. Certain roles may also be eligible for additional compensation (bonus, etc) and/or benefits. In addition, full-time employees are eligible for standard benefits package including paid time off, medical, dental, vison and retirement plan.