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Revenue Cycle Specialist

2 months ago

Columbia, Missouri, United States Columbia Orthopaedic Group Full time
Job Title: Revenue Cycle Specialist

Columbia Orthopaedic Group is seeking a highly skilled Revenue Cycle Specialist to join our team. As a key member of our revenue cycle team, you will be responsible for managing the revenue cycle processes, including charge entry, claims review, and handling claims for orthopedic services, anesthesia, durable medical equipment (DME), and radiology.

Key Responsibilities:
  • Charge Entry: Accurately enter and verify charges for orthopedic, anesthesia, DME, and radiology services into the billing system. Ensure all charges reflect the services provided, including proper coding and documentation.
  • Claims Review and Submission: Prepare, submit, and track insurance claims for orthopedic, anesthesia, DME, and radiology services using appropriate billing software. Verify that all claims are submitted in accordance with payer guidelines and coding standards.
  • Claims Follow-Up and Resolution: Monitor and follow up on outstanding claims, denials, and rejections to ensure timely resolution and payment. Investigate claim denials and rejections by reviewing claim history, communicating with insurance carriers, and making necessary corrections or adjustments.
  • Compliance and Documentation: Stay current with insurance policies, billing regulations, and compliance requirements specific to orthopedic, anesthesia, DME, and radiology services. Ensure all billing and claims processes comply with federal, state, and payer-specific regulations and guidelines.
  • Reporting and Analysis: Generate and analyze reports related to charge entry, claim status, denials, and reimbursement trends for orthopedic, anesthesia, DME, and radiology services. Identify and address any trends or issues affecting the revenue cycle and provide recommendations for improvement.
Qualifications:
  • Education: High school diploma or equivalent required; Associate's or Bachelor's degree in Healthcare Administration, Business, or a related field preferred.
  • Experience: Proven experience in medical billing and coding, preferably in an orthopedic, anesthesia, DME, or radiology setting.
  • Skills: Proficiency in medical billing software and electronic health record (EHR) systems. Strong understanding of billing processes and coding for orthopedic, anesthesia, DME, and radiology services (CPT, ICD-10, HCPCS). Excellent communication, analytical, and problem-solving skills.
Certifications (Preferred):
  • Certified Professional Coder (CPC) or Certified Coding Specialist (CCS). Certification in medical billing and coding (e.g., AAPC, AHIMA).
Working Conditions:
  • Environment: Office setting within the orthopedic practice.
  • Hours: Full-time position, typically Monday to Friday with standard office hours.