Careers
Orthopedic Associates of Northern California is dedicated to providing the highest quality orthopedic care. In order to do so, a great team is paramount. Below is a list or our current career opportunities. If you don’t see an opportunity that fits your skill set, stay tuned. We always looking for talented people.
Reimbursement Specialist
POSITION: Reimbursement Specialist-Tasks may be assigned by functional area
RESPONSIBLE TO: Operations Manager
JOB SUMMARY: Follows up on rejected claims and overdue insurance balances using Explanation of Benefits form and reports. Builds and maintains relationships with specified payors. Manages patient A/R, statement processing, and considering accounts for outside collections.
EDUCATIONAL REQUIREMENTS:
- High school diploma required
- Certified Coder a plus
QUALIFICATIONS AND SKILLS:
- Minimum eighteen months experience working in a physician group practice billing department
- Familiar with CPT and ICD-10 CM coding for orthopedic surgery
- Comfortable using email and interacting with Internet applications
- Knowledge of practice management and Microsoft office software
- Knowledge of AthenaHealth a bonus
- Able to establish good relationships with insurance companies
- Good analytical skills with an affinity for detail
- Ability to read and analyze accounts receivable and payor reports
- Pleasant speaking voice and demeanor
- Neat, professional appearance
- Strong written and verbal communication skills
- Accurate and fast date entry skills
Essential responsibilities include, but are not limited to:
Claims Filing
- Processes all paper and electronic claims for assigned carriers-verifies completeness
- 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
Account Follow Up
- Using date 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
- Uses payor policy manuals (often found online) to support completion of assigned tasks
- Responds to written and telephone inquiries from insurance companies
- Manages relationships with personnel from assigned carriers
- Meets with Billing Lead and Supervisor regularly to discuss and solve reimbursement and insurance follow up problems
- Calls carrier to appeal payments that do not match contractual agreement; notifies Manager of payors for which this is a consistent problem
- Asks physicians to provide appeal language for denials and unacceptable payment
- Processes requests for insurance refunds, and submits to Billing Supervisor for approval
- Responds to written and telephone inquiries from patients regarding their insurance questions
Patient Accounts
- Uses monthly aged accounts receivable report to identify and call patients with overdue balances of greater than 60 days; complies with the Fair Debt Collection Practices Act when calling patients
- Establishes payment plans within approved guidelines-obtains approval from the Supervisor when necessary
- Enters payment plan agreements into the EMR and reviews resulting reports monthly to ensure patients comply
- Resubmits insurance claims on behalf of patients, if necessary
- Prepares account status report monthly, showing detail about large balances; distributes to Supervisor
- Recommends to Supervisor those accounts needing to go to an outside collection agency
- Processes requests for patient refunds, and submits to Supervisor for approval
- Meets with Supervisor monthly to discuss and solve collection problems
- Prints and mails itemized statements to those patients who request them, or transmits claims to outside mailing house for processing
Payment Posting
- Posts all mailed-in payments and electronic payments by line item; posts adjustments, withholds, as part of this process, and transfers deductibles and co-insurance to patient responsibility; batches them according to protocol
- Alerts manager when payments do not match contractual amounts; looks for underpayments and silent PPO’s
- Submits balanced payment batches to the manager daily
- Other shared or Common Duties
- Maintains detailed knowledge of practice management and other computer software as it relates to job functions
- Maintains patient confidentiality; complies with HIPAA and compliance guidelines established by the practice
- Attends regular staff meetings as requested
- Attends continuing education sessions as requested
- Performs any additional duties as requested by the Manager
Supervisory Responsibilities
This job as no supervisory responsibilities
Typical Physical Demands
Work may require sitting for long periods of time, and also stooping, bending and stretching for files and supplies. Employee will occasionally be asked to lift files or paper weighing up to 30 pounds. Position requires manual dexterity sufficient to operate a keyboard, operate a computer, telephone, copier, and other such office equipment as necessary. Vision must be correctable to 20/20 and hearing must be in the normal range for telephone contacts. Position also requires viewing computer screens and typing for long periods of time, and working in an environment which can be very stressful.
Typical Working Conditions
Work performed can sometimes be in a reception area, and involves frequent contact with patients. Work may be stressful at times. Interaction with others is constant and interruptive.
Job Type: Full-time
Benefits:
Comprehensive Package after introductory period to include: Medical, dental, vision coverage. Other available coverages: accident, critical illness, life insurance, and short term disability.
- 401K benefit package available after 1 year.
- Salary: $29,000.00 to $35,000.00 /year
All openings are posted via Indeed.com and resumes can be emailed to jobs@oanc-chico.com
