Insurance Follow-Up Representative-Surgical Collections

Healthcare Outcomes Performance Co. (HOPCo); Florida; On-site; USD 40,000 - 60,000; Full time

Benefits offered by this job

Health benefits

HSA contributions

401(k) plan with match

Paid time off

Paid holidays

Job summary

Center for Bone & Joint Surgery is seeking an experienced Insurance Follow-Up Representative-Surgical Collections to join our Revenue Cycle team. This onsite role handles complex surgical accounts receivable, resolves denials and appeals, and maximizes reimbursement for orthopedic services.

The position requires CPC/CCS certification and 2+ years of medical billing or revenue cycle experience, with emphasis on orthopedic coding and Athena EMR proficiency.

Qualifications

• 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.
• 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.

Responsibilities

• 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.

Skills

CPC/CCS cert

Medical billing

Denial management

Athena EMR

Orthopedic billing

Tools

Microsoft Windows

Billing platforms

Job description

Center for Bone & Joint Surgery is a multi-location medical practice devoted to the diagnosis and treatment of injuries and diseases of the body's musculoskeletal system. Our locations feature a staff of highly trained orthopedic surgeons, each with a specific area of expertise. We offer a team approach to your care and provides a variety of services right on campus designed for your convenience and ensuring an outstanding continuum of care. These include on-site X-ray, on-site MRI, on-site physical therapy. As Center for Bone & Joint Surgery continues to grow, we are seeking an experienced and results-driven Insurance Follow-Up Representative-Surgical Collections to join our Revenue Cycle team. This full-time, onsite position is responsible for managing complex surgical accounts receivable, resolving claim denials and appeals, securing appropriate reimbursement, and optimizing revenue recovery for orthopedic surgical services.

Essential Functions

• 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.

Qualifications & Experience

• 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.

Knowledge & Skills

• 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.

Benefits

At Center for Bone & Joint Surgery, we are dedicated to taking care of our team members so they can focus on delivering exceptional care and service. Our comprehensive benefits package includes:

• Competitive Health & Welfare Benefits available after 30 days of service
• Monthly $43 stipend to apply toward ancillary benefits
• Health Savings Account (HSA) with qualifying HDHP plans and company contributions
• 401(k) plan with company match
• Employee Assistance Program (EAP) available 24/7
• Paid Time Off (PTO)
• Paid Holidays
• No evening or weekend
• Business hours Monday -Friday 8am - 5pm
• And more!

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.