Insurance Follow-Up Representative-Surgical Collections

• Review and resolve complex surgical claim denials, underpayments, and rejections by identifying root causes and executing effective appeal strategies.
• Analyze denied and unpaid orthopedic surgical claims and submit well-supported appeals to maximize reimbursement.
• Verify patient demographic information, insurance eligibility, and coordination of benefits; update records as needed to ensure accurate claim processing.
• Confirm claim receipt with insurance carriers and monitor claim status to facilitate timely payment.
• Research and obtain all required documentation, operative reports, medical records, referrals, and authorizations to support claim adjudication and appeals.
• Interpret and apply payer-specific reimbursement guidelines, medical necessity requirements, and billing policies.
• Review coding, modifiers, and claim edits to ensure compliance with CPT, ICD-10, and payer-specific billing requirements.
• Take ownership of assigned accounts receivable and proactively work aging accounts to reduce outstanding balances.
• Analyze accounts for accurate claim processing and payment posting, responding to inquiries from patients, providers, and staff.
• Identify denial trends, payer issues, and revenue cycle opportunities and communicate findings to leadership.
• Maintain productivity and quality standards while adhering to all company policies and Revenue Cycle procedures.

• Certified Professional Coder (CPC), CCS, or equivalent certification preferred.
• Minimum 2 years of experience in medical billing, collections, insurance follow-up, or revenue cycle management.
• Strong experience with orthopedic surgical billing, denial management, and appeals.
• Experience with Athena EMR and billing platforms is highly preferred.
• Demonstrated success recovering revenue from complex surgical claims across multiple payer types.
• Working knowledge of surgical coding, global periods, bundling edits, modifiers, and payer reimbursement methodologies.
• Excellent written and verbal communication skills with the ability to effectively interact with insurance representatives, providers, and patients.
• Strong analytical, organizational, and problem-solving skills with exceptional attention to detail.

• Advanced understanding of ICD-10-CM, CPT, surgical modifiers, and orthopedic coding guidelines.
• Knowledge of physician billing processes and payer-specific reimbursement policies.
• Experience with healthcare billing systems; 
• Advanced computer skills, including proficiency in Microsoft Windows-based applications.
• Strong knowledge of insurance claims processing, denial management, appeals, reimbursement methodologies, and accounts receivable follow-up.

If you have a strong background in orthopedic surgical collections, denial resolution, coding, and appeals, and are passionate about maximizing reimbursement while ensuring compliance and accuracy, we encourage you to apply and become part of the Center for Bone & Joint Surgery team. Your expertise will play a critical role in supporting our providers, patients, and continued organizational growth.

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.

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