Responsible for maintaining clinic professional charges, including updating procedure and diagnosis codes and associated fee schedules in the practice management system. This role analyzes reimbursement data to identify and resolve variances, supports refund processing, and helps maintain revenue cycle accuracy.
- Updates and maintains fee schedules with payer allowed amounts.
- Monitors CMS and commercial payer updates for reimbursement policy changes.
- Reviews carrier variance reports and researches payment inconsistencies.
- Appeals underpayment errors and identifies payer trends.
- Validates insurance overpayments and processes patient and insurance refunds.
- Reconciles deposits and unapplied balances at month end.
- Tracks KPI and revenue cycle metrics, builds reports and dashboards, and performs root cause analysis.
- Communicates with patients, carriers, and staff professionally.
- Supports teamwork, training, and compliance with organizational policies.
Requirements & Qualifications
- High school diploma or equivalent required.
- Previous medical billing experience required, preferably in orthopedic surgery.
- Current Certified Professional Coder (CPC) certification required.
- Proficiency with practice management systems and Microsoft Excel.
- Knowledge of medical terminology and human anatomy.
- Knowledge of medical billing, coding, insurance processes, and reimbursement practices.
- Strong attention to detail and accuracy.
- Excellent oral and written communication skills.
- Ability to manage high-volume work and troubleshoot practice management system issues.
Location
Ohio, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
1 week ago
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